• * Required

  • Family Questionnaire

  • Marital Status:
  • Are you a single parent household?
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Who is the main point of contact?*
  • Format: (000) 000-0000.

  • Parent's Work Information


  • * Required

  • Children Information

  • Other person(s) living in household

  • Household Information

  • Do you have pet(s)?*
  • Where are your pet(s) kept?*
  • Will care be required for your pet(s)?*
  • Does anyone in the home smoke indoors?*
  • Do you currently employ other help in the home, (cleaning services, personal assistants etc.)?*
  • Do you plan to continue the above service?*
  • Are there additional residences or buildings on the property that may require staff support?
  • Will the childcare provider work at or from vacation home or other properties?*


  • * Required

  • Job Description

  • Start Date:*
     / /
  • Position (Check all that apply):*

  • Start & End Times

  • Rows
  • Flexibility Essential?*

  • Salary

  • Compensation Guidance for Long-Term Childcare Placements

    Deb’s Domestic Agency specializes in long-term private household placements. Compensation should reflect the schedule, scope of responsibilities, number and ages of children, infant care, travel expectations, household support duties, schedule demands, live-out structure, and the candidate’s level of private household experience.

    As a general guide, part-time childcare searches typically begin around $40,000 annually for schedules up to approximately 25 hours per week. Full-time nanny placements commonly begin around $65,000+ plus benefits in smaller metropolitan markets and approximately $80,000+ plus benefits in larger or more competitive markets.

    Competitive full-time compensation packages often include paid time off, paid holidays, and health insurance or a health stipend. Families seeking long-term household stability, flexibility, discretion, and prior private household experience should expect compensation and benefits that reflect those expectations.

  • Pay range (annual gross salary, please check all that apply):*
  • Position(s) Needed: (Check all that apply):*
  • Service(s) Needed (Check all that apply):*
  • Skills Required (Check all that apply):
  • Does the employee need to have a driver's license?*
  • Do they need to have a car?*
  • Is there access to public transportation?*
  • Will the child caregiver be expected to drive as part of their duties?*
  • If yes, will a car be provided on the job?*
  • Will the child caregiver be expected to work regular or occasional overnights? (Overnights and travel can be included in the salary for live-in and live-out child caregivers if your family needs this service regularly.)*
  • Benefits (Check all that apply to the position):*
  • In the event of the Employee's termination, which of the following are you prepared to offer?


  • * Required

  • Accommodations (if applicable)

  • Live-In Accommodations (check all that apply)

  • Qualifications For The Employee

  • What criteria do you prefer of your future employee?*
  • What are your ideal educational requirements for an employee?*
  • What qualities are you looking for in your employee?*

  • Relationship With The Employee

  • What type of relationship do you want to have with your employee?*
  • Employee should be willing to work:*


  • * Required

  • Agreement

  • By signing your name below & submitting the form, you agree to Deb's Domestic Agency's ("DDA") terms and conditions. I certify that the above information is true and complete. I understand DDA will start the search for a domestic employee upon payment of the non-refundable $175 Registration fee that will be sent in another email, ONLY if DDA takes me on as a client. I understand what the final placement fee would be to the agency once there is a successful match and that I am to pay the employee separate from the agency. I understand what the final placement fee would be to DDA if there is a successful placement; and it is my responsibility to contact DDA if I am uncertain of anything listed in this agreement.

  • To sign:


    From a cell phone: Use your finger on your cell phone screen
    From a laptop: Use your finger on your trackpad
    From a desktop: Use your mouse

  • Should be Empty: