The Nannies of CLP

Providing The Nurture And Love Your Child Deserves

The Nannies of Children's Learning Place makes it convenient for you to submit your family application. Please

fill out the form below. It will be e-mailed directly to us and we will call you right away to complete the

application process. Or, if you wish, please open and print our family application in Adobe Acrobat and then

either mail or fax the completed signed application to:

The Nannies of Children's Learning Place
11 East Hubbard Street, Suite 7A
Chicago, IL 60611
Phone 312-923-9628
Fax 312-923-9886

families@nanniesofchicago.com

Personal Information

Name:

Address:

City:	State: Zip:
Home Phone: Business Phone:
Cell Phone: E-mail:
Home Fax: Work Fax:
Fed Ex Billing#:

Nanny Au Pair Both

Live in (Nationwide) Live Out (Chicago Area Only)

Start date of candidate: Expected salary:

Nearest major city: Distance in miles:

Mass transit accessibility:

Marital status: Spouse's name :

Please provide the following information about your children:

Please describe any special needs of the children:

Please describe your home(s) including quarters for Nanny:

Do you have domestic help? Yes No

Are there any pets in your home? Yes No

Is a car available for Nanny? Yes No

Family Setting

Mother's Employer:

Title:

Supervisor's Name & Phone:

Business address:

Frequency and duration of travel:

Father's Employer:

Title:

Supervisor's Name & Phone:

Business address:

Frequency and duration of travel:

Briefly describe the personality of you and your spouse:

Please describe your family's favorite interests or hobbies

What type of personality do you seek / what type of responsibilities will be required? Please detail average

hours per day, approximate start and ending times, days on duty, frequency of evening sitting, travel required,

etc.:

Personal References (please provide two personal references)

Name: Phone:

How were you referred to us?

I certify that the facts contained in this Family Application are true and complete to the best of my knowledge

and understand that falsification of this Application in any detail is grounds for disqualification from further

consideration for placement of a nanny. I further agree that any false or misrepresentation made on this

Application will invalidate any right to a refund and/or replacement under the Nannies of Children’s Learning

Place Referral Agreement.

I authorize investigation of all statements contained herein and authorize you to contact all the references listed

above, and others, to give you any and all information concerning employment and any pertinent information they

may have; and release all parties from all liability for any damage that may result from furnishing same to you.

I agree to inform the Nannies of Children’s Learning of any changes to the above information that may affect the

nanny’s employment in my home.

Online Family Application

11 East Hubbard Street • Chicago, IL 60611 • (312) 923-9628 • nannies@nanniesofchicago.com

Name	Sex	DOB	Grade	School Schedule
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