Family Request for Services Form for a Live-In Nanny
Heaven Sent Nanny
Your Name
*
First Name
Last Name
Your Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Your place of employment?
*
Your occupation
*
What service can we help you with?
*
Live-In Nanny
Live-In Nanny/Household Manager
Mother's helper
Target Start Date
*
-
Month
-
Day
Year
Date
Is your start date flexible?
*
Yes
No
How many hours a week do you need help?
*
Do you need the nanny to drive?
Yes, I need a nanny with a driver's license
No, I don't need the nanny to drive
Maybe
Please list children names and ages?
*
Do any of your children have special needs or health considerations or allergies? If so, please explain.
*
Do you have pets? If so, what kind?
*
Do you have other domestic help?
*
Housekeeper
Household Manager
Assistant
Chef
Driver
Security
No
Other
Have you employed a nanny or Au Pair before?
*
Yes Live-In Help
Yes Live-Out Help
No
Any other perks or benefits you plan on providing?
*
Gym membership
Cell phone reimbursement
Car to use on personal time
Gift cards
Gas cards
Travel with family
Health insurance
Tuition reimbusement
401K
Free day from time to time for excellent service
Holiday bonus
Guaranteed hours
Stay on another year bonus
None
Other
Are you providing a vehicle for the nanny to drive for work related errands?
*
Yes
No
Maybe
We can talk about it
Are you providing a vehicle for the nanny to drive for personal use
*
Yes
No
Maybe
We can talk about it
Do you need the nanny to travel with you?
*
Yes
No
Maybe
Does the nanny need a passport?
*
Yes
No
Maybe
Will your Live-In help have her own private bathroom?
*
Yes
No
Share with kids
Guest bathroom
N/A Looking for Live-Out help
What is the age range of the nanny you are looking for?
*
What level of experience are you looking for in your candidate?
*
Beginner
Some experience
Several years' experience
A mom with grown children
Grandma type
Open to any level of experience
Other
What is your compensation range are you offering based on 40 hours?
*
Beginner nannies $600.00-$800.00 weekly ($15.00-$20.00 an hour)
Has some live-in exp $800.00-$1,000 weekly ($20.00-$25.00 an hour)
Has several years live-in exp $1,000-$1,200 weekly ($25.00-$30.00 an hour)
$1,200 Plus $30.00+ an hour
Other
is there a religion you are requesting your candidate to be?
Christian
Catholic
Mormon
Jewish
Hindu
Spiritual
Any religion is acceptable
Other
Please feel free to share your family religion
Are you looking for your candidate to speak a foreign language?
*
Spanish
French
German
Korean
Italian
No
Other
Please describe family location
Is there anything else that you would like to tell us about your children, family, or the position?
I understand that there is a $79.00 starter fee once you have spoken to a team member, and you have decided to move forward with the process and want our help seeking candidates.
*
Yes, I agree to pay the starter fee if I desire to move forward with the application process after speaking with someone
No, I don't want to pay the starter fee and don't desire to move forward with the process.
Other
How did you hear about us?
*
Please send us a family photo
Please verify that you are human
*
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