Parent Application Form Nanny/ Babysitter
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PARENT INFORMATION
Parent (a) Name
Parent (b) Name
Address 

Street

City

State

Zip

Email
Phone Number (a)
Phone Number (b)

Preferred method of contact

Best time to contact you? 
Parent (a) Occupation 
Parent (b) Occupation 

Position Preference

 Type of care

Hours

Shift Start and  End Time 

Preferred days

Anticipated Start date 
MM
/
DD
/
YYYY
Number of children for specific care 
Child Name 
Gender
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Age
Grade
Child Name 
Gender
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Age
Grade
Child Name 
Gender
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Age
Grade
Any health concerns, allergies, special needs you wish to disclose? 

Extra-curricular activities or interests?

Have you ever employed a Nanny / NCS / Driver before?

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Do you use cameras in you home? 

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Does a parent work from home?

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Responsibilities 

Do you have pets

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Do you need me to driver?

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If yes, how many miles per day? 

Will you provide a vehicle, or should driver have their own vehicle?

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Does this position require travel?

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Personal Preference

Describe Your Ideal Candidate

Describe You Method for Guidance

Describe A Typical day on the job

Is There Any Additional Information You Would Like Us To Know About Your Family?

How did you hear about Gem’s Ensuring Moms?

If You Were Referred To Us From A Friend Please Tell Us Their Name So We Can Send Them A Thank You
Additional Scheduling Information
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I certify the information provided in this application is true and correct to the best of my knowledge. I understand that Gem’s Ensuring Moms, LLC is a referral service for household employees and Gem’s Ensuring Moms, LLC does not employ caregivers. The caregiver is contracted by Gem's Ensuring Moms. I give Gem’s Ensuring Moms, LLC authorization to share the information on this application with prospective candidates for only the purpose of finding a caregiver for your family. I understand that upon receipt of this application, I will receive a phone call from a Gem’s Ensuring Mom's representative and will be asked to book a complimentary consultation. A $300 application fee is due at the conclusion of the consultation. I further understand that this non-refundable fee is my only obligation to Gem’s Ensuring Moms, LLC, and must be received to start the screening process of my potential caregiver. Screening includes a background check, drug test, and reference check. 


 

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