0 Nanny Agency Reference Form Please enable JavaScript in your browser to complete this form.Your Name as a reference *FirstLastPlease NOTE that all the information you give us will be kept CONFIDENTIAL.Phone *We will want to call you to confirm the details in this referenceEmail *Nanny's Name *FirstLastAddress where the nanny worked for you: *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMonth/Year she started and Finished work *How did she come to work for you? *How old were your children when she started? *Did you both work outside the home? *Was it a live in or live out position? *Live outLive inDid she work Full time or Part time? *Full TimePart TimeWhat were her duties (please check all that apply) *ChildcareLight HousekeepingKids' Laundry/MealsAdults' Laundry/MealFull HousekeepingErrandsDrivingWhat were her strengths? *Please discuss her reliability *Safety conscious/good judgement? *Please check ANY of the following that apply to her *Kept the children engaged in age appropriate activitiesCreative in playShe always showed initiativeShe followed instructions wellShe was a good communicatorShe is organizedShe is health consciousShe is non-smokerThe kids are very fond of herSafe driverDid she ever take care of the kids while you travelled?Any negative experience you can share?Why did she leave? *Would you rehire her if you were back there again? *EmailSubmit