• * Required

  • Family Questionnaire

  • Who is completing this request?*
  • 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?*
  • Number of rooms:
  • Will the childcare provider work at or from vacation home or other properties?*


  • * Required

  • Job Description

  • Start Date:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Employment schedule (select one)*
  • Living arrangement

  • Start & End Times

  • For each day, please list the employee's approximate start and end times:*
    Rows
  • Flexibility Essential?*

  • Salary

  • Compensation Guidance for Long-Term Childcare Placements

    Deb’s Domestic Agency specializes in long-term private household childcare placements. Compensation should reflect the role, schedule, responsibilities, experience required, number and ages of children, travel expectations, household support duties, and market.

    All DDA childcare placements are salaried positions. Part-time placements generally begin around $60,000 in annual base salary. Full-time compensation varies by role, with current guidance beginning around $80,000 for a Professional Nanny and increasing for more specialized or senior positions.

    Current full-time annual base salary guidance:

    • Professional Nanny — $80,000
    • ROTA / Rotational Nanny — $85,000
    • Overnight / Night Nanny — $100,000
    • Lead Nanny — $110,000
    • Family Assistant — $120,000
    • Lead ROTA / Lead Rotational Nanny — $125,000
    • Governess / Private Educator — $140,000

    For blended or hybrid roles, DDA uses the highest applicable role guidance. These figures are compensation guidance rather than automatic rejection thresholds. Families may submit a proposed salary below current guidance for DDA review.

    Competitive packages may also include paid time off, paid holidays, health insurance or a health stipend, and other benefits. Benefits and supplemental compensation are considered separately from annual base salary.

  • Pay range (annual gross salary, please check all that apply):
  • Full-Time Annual Base Salary Range
  • Position(s) Needed (Check all that apply): Select all that apply. For blended positions, DDA will evaluate compensation based on the highest-level responsibilities selected.*

  • Personalized Compensation Guidance

    Optional, private guidance to help align the childcare role, schedule and competitive compensation before the search begins.
  • List additional position(s) not mentioned above:
  • Service(s) Needed (Check all that apply):*
  • List additional service(s) you need, which were not mentioned above:
  • 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?*
  • 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?*
  • Please list any other educational requirements not mentioned above:
  • Please list any Foreign Language(s):
  • What qualities are you looking for in your employee?*
  • List the most important qualities you are looking for in an employee:*
  • List what Religious/Religion qualities you are 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

  • Signature*
  • Should be Empty: