Family Application
palmconciergeagency@gmail.com
Parent Name
First Name
Last Name
Parent Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Start Date
-
Month
-
Day
Year
Date
Will your employee be a live-in or live-out?
Live-in
Live-out
Please write which service you're looking for.
Please list the desired schedule below.
List name/age of Children. 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?
What light housekeeping duties will your nanny be responsible for? (n/a if not applied)
Pick which words best describes your family?
Fun
Structured
Athletic
Organized
Funny
Laid back
Health conscious
Busy
Creative
Loving
Other
Have you employed a Nanny or Au Pair before?
Yes
No
N/A
Thanks, will your employee be required to work regularly/scheduled shifts?
Yes
No
N/A
What salary range are you offering? (n/a if not applied)
What benefits will you be providing?(n/a if not applied)
How will you pay your service provider:
How did you hear about PCA?
Will your nanny be responsible for running any errands or grocery shopping on the job? If yes, please list. (n/a if not applied)
Are you open to having a nanny take your children outside of the home for child related activities?(n/a if not applied)
What are 5 of the most important qualities you value in a Nanny?
Open
Honest
Structured
Nurturing
Trustworthy
Flexible
Timely
"Can do attitude"
Loving
Creative
Engaging
Organized
N/A
Is there any additional information about your family/family situation that our team should know before beginning your search?
Is there anything else that you would like to tell us about your children, family, or the position?
Date for phone call
Payment
will be invoiced to you for CC charge
You can view the fees for all services by visiting our website.
E-mail For Invoice
Submit
Hourly rate you’re looking to pay:
Should be Empty: