Nooks & Nannies Questionnaire

Values questionnaire (Section 1 of 5)

What are you, as an individual, passionate about?

What/who inspires you?

What values and qualities do you wish your Nooks & Nannies staff to exemplify?

What values do you want to pass on to your children?

Reverse qualities: List several behaviours that you do not like, and then reverse them to see more values that are important to you. Examples: rudeness/politeness. aggression/peacefulness.

Describe your most treasured moment.

What activities do you love to participate in? a. As an individual

b. As a family

What are the qualities that you love about your best friends?

What in life is important to you?

Give some examples of situations, i.e. previous jobs that were not positive experiences for you, and then list the reverse quality. For example, controlling supervisor/need for autonomy. Lateness/promptness.

Parent information (Section 2 of 5)

Last name:

First name:

Middle initial:

Last name:

First name:

Middle initial:

Language(s) spoken at home:

Smoker?

Street Address:

City:

Province:

Postal code:

Phone number:

Email address:

Secondary phone number:

Secondary email address:

Child information (Section 3 of 5)

Last name:

First name:

M.I.:

Date of birth:

Favourite activities:

Food likes/dislikes:

Personality:

Medical issues:

Allergies:

Special needs:

Language(s) spoken at home:

Have you worked with a nanny or an agency before?

Yes

Second child (optional)

Last name:

First name:

M.I.:

Date of birth:

Favourite activities:

Food likes/dislikes:

Personality:

Medical issues:

Allergies:

Special needs:

Language(s) spoken at home:

Have you worked with a nanny or an agency before?

Yes

If yes, when? Explain.

Services (Section 5 of 5)

Do you need full time child care? Yes

If no, please list the days & hours needed.

Is driving required? Yes

If yes, will you provide a vehicle? Yes

Please let us know what kind of services you require:

Housekeeping

✓

Comments

Cleaning

Cooking

Dog walking/pet care

Errands

Gardening

Ironing

Laundry

Secretarial (planning/coordinating)

Shopping

Tidying

Meal Planning

Other

Child care

✓

Comments

Waking/dressing children

Changing diapers/toilet training

Morning routine

Feeding bottles/snacks/meals

Before school care

Dispensing vitamins/medicine

Transporting children

Nap time

After school care

Helping with homework/reading together

Outdoor activities

Crafts

Music

Extracurricular classes/sports

Bathing/personal hygiene

Bed time routine

Other

Would you allow a child care worker to bring their own child to work occasionally?

Yes

Thanks for your application

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Pet name:	Type of pet:	Details:
Pet name:	Type of pet:	Details:

Values questionnaire (Section 1 of 5)

Parent information (Section 2 of 5)

Child information (Section 3 of 5)

Second child (optional)

Pet information (Section 4 of 5)

Services (Section 5 of 5)

Thanks for your application