Family Application for Permanent Nanny Placement Step 1 of 6 - Parent Info 16% Parent InformationParent #1Name* Email* Primary phone number* Type*CellHomeWork Add another phone number Alternate phone number TypeCellHomeWorkOccupation* Employer* Parent #2Name* Email Primary phone number TypeCellHomeWork Add another phone number Alternate phone number TypeCellHomeWorkOccupation Employer Home InformationHome phoneAddress* Street Apt/Suite City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Does anyone in the family smoke?* Yes No Has either parent been convicted of a misdemeanor?* Yes No Has either parent been convicted of a felony?* Yes No Child InformationChild information*Write your child's name, gender, DOB, and any other special information. Click the + icon to add another line for another child.NameGenderDate of BirthOther Information (Allergies, Special Needs) Pet InformationPet informationWrite your pet's name, type, breed and weight. Click the + icon to add another line for another pet.NameTypeBreedWeight Have you ever had a nanny before?* Yes No Is there anything you'd like us to know about your family's past experiences with a nanny? Job SpecificsWhat type of nanny are you seeking? Check all that apply* Full time Part time Live in Live out Anticipated start date* MM slash DD slash YYYY Please describe your living quarters*I need my nanny to work or be on call....*DayTime Click the + icon to add another row.Special skills you want your nanny to haveQualities you are looking for in a nanny*Nanny Job Specifics Housekeeping Cooking Driving (own car) Driving (family car) Travel availability Major holiday availability Specifically describe the housekeeping workSpecifically describe the cooking workSpecifically describe the driving (own car) workSpecifically describe the driving (family car) workSpecifically describe the travel availability workSpecifically describe the major holiday availability workWill you object to your nanny smoking outside your home?* Yes No CompensationProposed hourly salary range (min-max)* The amount paid a Permanent Nanny will vary based on numerous variables within your employment arrangement. Your NWNannies advisor will review your specific situation with you and answer any questions you may have during your consultation.Is your salary offer negotiable?* Yes No Benefits Available to Your Nanny* Paid Vacation Days (Standard for full-time nannies, generally ranging from one to three weeks per year.) Paid Federal Holidays (New Year's Day, Memorial Day, 4th of July, Labor Day, Thanksgiving Day and the day after, Christmas Day.) Paid Sick Leave (Full-time nannies typically receive 3-5 paid sick days per year.) Tax Withholding (Federal and State) Social Security (Employer match) Health Insurance Other What other benefits are you offering? Is there any other information you'd like to share with us about your family now? We're looking forward to serving you. Application FeePermanent Family Application Fee* Price: Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Security Code Cardholder Name How did you hear about us? Google Search Word of Mouth/Referral Social Media Newspaper Radio Other HiddenDo you remember their name?