Nurturing Your Needs, Together PARENT INTAKE FORM Parent Intake Form Parent(s) /Guardian Name * Years of Experience Preferred * Phone number * Country (###) ### #### Home Address Scheduling Preferences : Days and Hours needed and any specific scheduling requirements or flexibility Years of Experience Preferred 1-5 years 5-10 years 10-15 years 15 + years Household Details: Any Specific duties expected beyond childcare. * Total weekly available hours? What is the hourly rate for this Nanny position? 25-30 30-35 35-40 40-45 45+ Which Candidtate tags would you prefer for them to have to be considered? CPR Certificaton First Aid Certification Drivers License Owns a Car Legally allowed to work in the U. S With Work Visa ( non-citizen ) Comfortable with Pets Expereince with Special Needs Child(ren) Non-Smoker Clear Police Reord Willing to do light housekeeping Willing to cook for the family COVID-Vaccinated Please choose what type of nanny service you are looking for Full Time Nanny (40+ hours per week) Part Time Nanny (20-39 hours per week) Temporary Nanny (1- 6 months) Travel Nanny Overnight Nanny Do you prefer any level of education? Early childhood education College Degree Montessori Background Other What benefits are you willing to provide to your sitter Health Dental Vision Life Insurance Vacation (Paid) Vacation (Unpaid) Sick Leave Workers Comp None Other When would you ideally like your new hire to start? MM DD YYYY Any Pets? Please add Type of pet and any notes Comments/Requests: Any additional or special requests * Todays date MM DD YYYY OTHER INFORMATION How did you hear about us Friend Instagram Facebook TikTok Networking Event Google Other Thank you! We will get back to you in 48-72 hours. NANNY INTAKE FORM NANNY INTAKE FORM Legal Full Name * First Name Last Name Date of Birth * MM DD YYYY Contact Information: (Phone number, Email address) * Address: * Address 1 Address 2 City State/Province Zip/Postal Code Country Which candidate profile tags applies to you? This will be used in pairing you with the best family CPR Certification (we will ask for a copy) First Aid Certification (we will ask for a copy) Valid Drivers License Clean driving record and no offenses Owns a car Willing to use own Legally allowed to work in the U.S With work Visa ( non-citizen ) Comfortable with pets Experience with Special Needs Child(ren) Non-Smoker Clear Backround Check ( this will be done) Able to pass a drug test Willing to do light housekeeping Willing to cook for the family COVID-Vaccinated Please provide a brief desciption of yourself that you would like to be shared with potential families Please list your daily avalibility by listing days and times and any conflicts or potential future schedule changes Please list 3 or more verifiable non- relative references and a desciption of how long you were with them and their name and contact info. Applicant's Signature: * MM DD YYYY Thank you! We will get bac to yo in 48-72 hous! CLIENT VIRTUAL SUPPORT INTAKE FORM CLIENT VIRTUAL SUPPORT INTAKE FORM Full Name * First Name Last Name Business or Company Name * Other Email and Phone Number * Other What services are you interested In? * Email Management Calendar Management Travel Customer Support Executive Support Project Management How many hours per week do you require assistance? * What time zone * PST EST Are there specific skills or qualifications you require from your virtual assistant * Do you require your virtual assistant to have experience in a specific industry? (Yes/No, if yes, please specify) * Are there any specific software or online tools the virtual assistant needs to be proficient in? Other Any other information that you would like to share * Signed Name and Date * Thank you!
