Family Applicationfor Permanent Nanny PlacementFill out the online form below and press send. Alternatively, you can print out the PDF version and email or fax it to us. There is a one-time registration fee of $100.Step 1 of 6 - Parent Info16%Parent InformationParent #1Name*Email* Primary phone number*Type*CellHomeWork Add another phone numberAlternate phone numberTypeCellHomeWorkOccupation*Employer*Parent #2NameEmail Primary phone numberTypeCellHomeWork Add another phone numberAlternate phone numberTypeCellHomeWorkOccupationEmployer 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?*YesNoHas either parent been convicted of a misdemeanor?*YesNoHas either parent been convicted of a felony?*YesNo 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?*YesNoIs 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 outAnticipated start date* Date Format: 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 availabilitySpecifically 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?*YesNo 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?*YesNoBenefits 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 OtherWhat 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: $100.00 Credit Card*American ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Security Code Cardholder Name How did you hear about us? Google Search Word of Mouth/Referral Social Media Newspaper Radio OtherDo you remember their name? This iframe contains the logic required to handle Ajax powered Gravity Forms.