Thank you for taking time to fill out our family application for a part-time nanny. We look forward to working with you.

For questions or more information, contact Midwest Elite Nannies at 319-640-0332 or click here to contact us via email.

    *Indicates required field


    Parent #1

    Does Your Work Require You To Travel? YesNo

    If Yes, Please Explain

    Do You Ever Work At Home?* YesNo

    If Yes, Please Explain


    Parent #2

    Does Your Work Require You To Travel? YesNo

    If Yes, Please Explain

    Do You Ever Work At Home? YesNo

    If Yes, Please Explain


    Child #1

    MaleFemale

    Age:

    Allergies: YesNo

    If Yes, Please Explain

    Days in School:


    Child #2

    MaleFemale

    Age:

    Allergies: YesNo

    If Yes, Please Explain

    Days in School:


    Child #3

    MaleFemale

    Age:

    Allergies: YesNo

    If Yes, Please Explain

    Days in School:


    Child #4

    MaleFemale

    Age:

    Allergies: YesNo

    If Yes, Please Explain

    Days in School:


    Do Other Adults Live in Your Home?: YesNo

    If Yes, Whom?

    Do You Have Any Pets? YesNo

    If Yes, What Type?

    Will the Nanny be Require to Care for the Pet? YesNo

    If Yes, Please List the Duties the Nanny Would Need to Perform.

    How Many Times Per Year Do You Go On Vacation?

    What Type of Parent Are You? Easy GoingLenientNervousStrict

    Does Anyone in Your Home Smoke? YesNo


    Applying For: Full-TimePart-TimeSummer/Temporary

    Hours and Days Needed:
    Monday:
    Tuesday:
    Wednesday:
    Thursday:
    Friday:
    Saturday:
    Sunday:

    WeeklyHourly

    Please Indicate Benefits You Will Provide the Nanny: Health InsuranceGas ReimbursementFamily Vehicle

    Please List Number of Paid Vacation Days:
    We recommend 2 weeks of paid vacation, not including paid holidays.

    Please Indicate Paid Holidays: New Year's DayMemorial DayFourth of JulyLabor DayThanksgiving DayChristmas EveChristmas Day

    Will You be Withholding Social Security, Medicare, and Taxes From Your Nanny’s Earnings or Will That Be Left Up To The Nanny?
    YesNo(By law you are required to pay only social security, unemployment, and Medicare.)

    Is Driving Required by the Nanny? YesNo

    If Yes, Please Describe

    Is There a Car Available for the Nanny to Drive? YesNo

    If Yes, Please Describe Authorized Uses

    Is Travel Required by the Nanny? YesNo

    Is There a House Cleaner in Addition to the Nanny? YesNo

    If Yes, What Frequency?

    Have You Ever Employed an In-Home Child Care Provider? YesNo

    If Yes, Please Describe What Type and How Long?


    Please List Three References or Nannies That Know Your Family Well. Please Do Not Include Relatives

     

     

    To ensure the safety of the nanny as well as the family, Midwest Elite Nannies makes it a policy to check all references supplied. We guarantee that all information attained from the reference and background check process will only be used as part of the nanny selection and engagement process and kept strictly confidential.


    Please take some time when completing the next two questions, the more detail you can give us will help in your Nanny search.


    Statement of Truth for Application:* By submitting this application, I hereby state that there are no criminal acts being conducted in our home. We certify that our home is free of drug or alcohol abuse by any member of the family. We declare that there has not been any incidents of domestic violence in our family home that have been reported to the police. We also have the financial ability to pay the hourly rate and benefits as discussed with Midwest Elite Nannies to the nanny on a timely basis. I hereby certify that the information we have provided above is true and correct.