Nanny Agency Reference Form

Your Name as a reference *

First

Last

Please 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 reference

Email *

Nanny's Name *

First

Last

Address where the nanny worked for you: *

Address Line 1

Address Line 2

City

State

Zip Code

Month/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? *

Did she work Full time or Part time? *

What were her duties (please check all that apply) *

What were her strengths? *

Please discuss her reliability *

Safety conscious/good judgement? *

Please check ANY of the following that apply to her *

Did 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? *