Clone of Registry Application

1

Primary Contact Name* This field is required.

First Name

Last Name

2

Email Address* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Number of children and ages* This field is required.

5

Which role are you seeking?* This field is required.Select all that apply.

Nanny (Full-time Childcare)

Babysitter (On-call Childcare)

Family Assistant

Housekeeper

Other

6

Is this position:* This field is required.

Full-time

Part-time

Occasional/On-call

Temporary/Short-term

7

Are there any pets in the home?* This field is required.

YESNO

8

Are there any allergies, medical needs, or special considerations we should be aware of?* This field is required.

YESNO

9

Please list allergies, medical needs, or special considerations we should be aware of.* This field is required.

10

Desired Start Date* This field is required.

Date

12

Will driving be required as part of this role?* This field is required.

YESNO

13

Please describe the primary responsibilities for this role.* This field is required.

14

What qualities are most important to you?* This field is required.

15

Proposed hourly rate or salary range* This field is required.

16

Have you employed a nanny, family assistant, or housekeeper before?* This field is required.

YESNO

17

What worked well in that arrangement? What didn't?* This field is required.