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Employer Registration form
Form Version
Form:
Section 1: Personal Infomation
Last Name:
First Name:
Date Of Birth(YY/MM/DD):
Marital Status:
Number of Children
Age of Children
Language(s) Spoken
Country of Birth:
Nationality(s):
Section 1 (b): Employment infomation
Profession:
Do you operate a home businese Yes No
Car Ownership Yes No Rental
Driver's license? Yes No
Section 1 (c): Contact Infomation
Current Residential Address (With Zip/Postal Code)
Telephone # (Work):
Telephone # (Home):
Cellphone #:
E-mail:
Section 1 (d): Home infomation
Home Info: House TownHouse Condo
Bedroom:
Bathroom: Estimated Total Square Feet:
Will the nanny have her own room?
Yes No
Anybath?
Yes No
W/Lock?
Yes No
Section 2: Your Preference in your future nanny
What type of nanny are you looking for?
Live In Live Out
-
Full Time Part Time

If you had to select one, what would be the the type of specialized nanny you are looking for.
Infant Care Child Care Elder/Senior Disabled Babysitter HouseKeeper Others
if others, please specify.
Section 3: Child Infomation (optional)
You can skip to the next section if you are don't want the nanny to take care of your child/children.

First Child's Name:
Nickname:
Sex: Male Female
Birth Date:
Hobbies
Allergies from food/Medicine (Medical Concern)
Special Interests:
Enjoyed Food/Drinks:
Second Child's Name:
Nickname:
Sex: Male Female
Birth Date:
Hobbies
Allergies from food/Medicine (Medical Concern)
Special Interests:
Enjoyed Food/Drinks:
If you have any more children plz write thier infomation in the space provided

Section 4: Addition Tasks
Clean/Handling the Child?
Yes No
Clean Rooms?
Yes No
Laundry for Baby?
Yes No
Laundry For Family?
Yes No
Cook/Feed Baby?
Yes No
Cook for Family?
Yes No
Section 4(b): Special Tasks
Take your children to church?
Yes No
Pet Care?
Yes No
Gardening
Yes No
Snow/Litter Removal
Yes No
Discipline of Your Child
Yes No
Cook Different Style of food
Yes No
Snack/Party catering Service
Yes No
Section 5:
Please specify the following points:
Job Start Date:
Job Duration:
Hourly Rate:
For live-in Caregiver(Nanny), How Much is the Net Pay Monthly to The Nanny, after Deduction of Tax, Room,and board?

Age Preference:
15-20 20-30 25-30 30-35 35-40 40-45 50+


Any other notes you would like to add.



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