NANNIES DIRECT 

Bringing Families and Caregivers Together

 ( A Division of 2150026 Ontario Ltd.)

Nannies Direct
109 Broadway Avenue
Suite # 9
Orangeville, ON L9V 1A3
ph: 519-307-1114
fax: 519-307-1115

Family Application


Nannies Direct - Family Application




CONTACT INFORMATION:
Employer First Name:  Last Name: 
Current Address: 
City: Province:
Postal Code: Email: 
Home Phone: Work Phone: 
Cell Phone: Fax: 
Spouse's First Name: Last Name: 
Work Phone: Cell Phone: 
Best Time to Contact:

FAMILY INFORMATION:
Number of Adults in Household: 
Mother's Profession: 
Father's Profession: 
Language(s) Spoken in Home:

CHILDREN
 Name Sex Age Special Requirements
1.
2.
3.
4.
5.

ELDERLY/SPECIAL NEEDS INFORMATION
Name Sex Age Special Requirements
1.
2.

POSITION REQUIREMENTS

Schedule of Hours:

Will there be overtime (over 44 hrs/ week)?
Starting Date
Length of Employment:
Do you require that the Caregiver has a valid Driver's License?
Special Skills Required?

Do you require a caregiver/nanny that can swim?

CAREGIVER'S ADDITIONAL DUTIES AND RESPONSIBLITITES
Please check all that apply:        Light Housekeeping
Full Housekeeping
Laundry
Cooking

HOME INFORMATION

Please describe Caregivers Living Accommodations:

Private Bedroom Private Bathroom Shared Bathroom
Cable TV Own Phone Own TV
Other:
Location of Home:

Rural

Quiet Residential

Busy Residential
Do you Live within walking distance of :

Church

Shopping center

Public transportation

Description of Home:

Approx Sq. Footage: #Bedrooms # Bathrooms
Other Rooms: Swimming Pool
List Pets, if any:

Please share any other comments that you think would be helpful to us, such as families interests or hobbies:

How did you hear about our agency?








Copyright Nannies Direct . All rights reserved.

All Photographs Copyright Heather Greig 2007

 

 

 

Nannies Direct
109 Broadway Avenue
Suite # 9
Orangeville, ON L9V 1A3
ph: 519-307-1114
fax: 519-307-1115