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Family Application

If you feel more comfortable printing out a PDF of the application and mailing it to our offices we welcome that as well.

If you would like a copy of the Application sent to you please contact Vermont Nanny Connection and we will send you one. Don't forget to add your mailing address in the comment area.

Personal Information
Name
Occupation
Phone
Cell Phone
Email
Spouse
Occupation
Home
Address
City
State
Zip
Apartment Number
Children
Name Child One
Age Child One
Gender Child One male female
Name Child Two
Age Child Two
Gender Child Two male female
Name Child Three
Age Child Three
Gender Child Three male female
Name Child Four
Age Child Four
Gender Child Four male female
Name Child Five
Age Child Five
Gender Child Five male female
Nanny Qualifications
Full-time Part-time
Live-out Live-in
Permanent Temporary
Nanny Mother's Helper
Sitter Female
Male Non-smoker
18-19 yrs. old 20-30 yrs. old
31-40 yrs. old over 50 yrs. old
Swimmer Able to drive
Own a car Cooking skills
Athletic College education
Teaching certificate Prior nanny experience
Prior childcare experience Newborn/Infant experience
Toddler experience School age experience
Multiples experience Special needs
Childcare Requirements
Childcare is the nanny's primary responsibility. Please describe in detail the expected duties including childcare:
Normal Work Schedule
Please list your normal weekly work schedule below.
Other hours expected
Expected Gross Salary
Benefits you will offer Paid Vacations
Paid Holidays
Paid Sick Days
Medical Insurance Contribution
Other
References
Please list previous childcare providers if possible. List Name, Address, phone number, times to call, relationship and how long you have known the people listed below. Please list at least three (3) references.
Other Information
When will you need a nanny to start?
Do you require the nanny to transport children in her/his own car? yes
no
If yes, how will you compensate the nanny for work related driving?
Briefly describe the personality of you and your spouse:
Please describe your family's favorite interest or hobbies:
Do you have any additional information or comments that will help us make the most compatible match for you and the caregiver?
Where did you hear about us?
Submit