Family Questionnaire / Application

Contact Information
First Name:
Middle Name:
Last Name:
Email Address:
Address 1:
Address 2:
Postal/Zip Code:
Phone Number:
Work Number:
Fax Number:
Spouses name (if applicable):
Spouse's Occupation:
Are you employed outside of the house? Yes No
If no, please specify:

When do you need a nanny to start?
Should nanny portfolios be: Mailed Faxed
Do you need a live-in or live-out nanny? Live-in Live-out
What is your proposed gross weekly salary?

Nanny's work schedule as you anticipate it to be:

Nannies generally work 5 days a week, 8-9, 5 hrs day (depending on Provincial Labour Standard Laws)

Nannies are responsible for all child-care related duties and light housekeeping.
If you have needs beyond this, please specify:
Children living in your home: (Please include their names, age, sex, birthdate, and school hours)
Is a new child expected? Yes No
If yes, please estimate birth date:
Do any of your children require special care, medication, or therapy of any kind? If yes, please specify:
Please describe your family. Write about your life style, home activities, etc.
Do you have pets? If yes, for what part of their care is the nanny responsible?
Who, in addition to parents and children, lives in the home?
Will you have household help other than the nanny? If so, please describe:
What do you anticipate the nanny's child care responsibilities to be? Please describe:
What housekeeping responsibilities would you like the nanny to have?
Any special dietary considerations in the home? If yes, please explain:

Please describe your home?
District: Urban Suburban Rural

Distance to:
Public Transport:
Town / Shops:
Movie Theatre:
Nanny's Accommodation
Please describe the nanny's accommodations:
Will the nanny have her own bathroom? Yes No
If no, please specify:
Will the nanny drive as part of her job? Yes No
If yes, please specify:
Is there a car available for the nanny to use during her work day? Yes No
If yes, is it automatic or manual? Automatic Manual Not Applicable
Is the car a family automobile or is it specifically for the nanny? Yes No Not Applicable
If there is a car available for the nanny to use, is it available for her to use on evenings and days off?
Yes No Not Applicable
If the nanny brings her own car, how do you plan to reimburse her for insurance or gas if she uses it for errands and car pools?
Will the nanny be allowed to have visitors? Yes No
Will the nanny have a curfew? Yes No
List qualities that you are looking for in a nanny:
What previous childcare experience do you require?
How many nannies have you had in the past three years?
How long did each one stay? Where were they from? Why did they leave?
Please share your comments regarding favorable and/or unfavorable experiences with prior nannies:
Ideal Caregiver Qualities:
Required Experience:
Do you see the employee as a member of the family, or as an employee?
Will this be your first time hiring an employee of any kind?
What would/does make you a 'good' employer?
Do you currently employ a caregiver? Yes No
Number of past caregivers (either live-in or live-out):
How long did each one stay? Where were they from? Why did they leave?
Have you ever employed a foreign live-in caregiver? Yes No
Describe your current care arrangements:
Are you familiar with payroll procedures? Yes No
Should any proposed details stated above not be in accordance to standard, do you agree to abide by all Canadian taxation, and labour laws?
Yes No
Who can we thank for referring you to International Nannies & Homecare Ltd.?
How did you hear about us?
Final Comments: