We want to provide you with the most qualified staff member to meet your family’s unique needs. In order to do so, we ask that you fill out the form below. Once submitted, a representative will be in touch. Client 1 Client Name: Address: Phone: Email: Current Employer: Work Address: Work Phone: Work Email: Client 2 Client Name: Address: Phone: Email: Current Employer: Work Address: Work Phone: Work Email: Preferred Contact PLEASE ENTER YOUR PREFERRED CONTACT PERSON IF OTHER THAN THE CLIENT. Name: Job Title: Phone: Email: Other Information What is your ideal start date? Please provide a Detailed Job Description. Remember to include hours, salary and any benefits offered including sick, vacation, holiday pay, health benefits and if there is a car provided for work hours. If this is a live-in position include accommodations. By submitting this form, I agree to not hire any applicants sent to me by The Nanny Poppins Agency without first paying the appropriate fee to the Agency. I agree to not to contact any applicants that are sent to by/from The Nanny Poppins Agency without first providing the Agency with a signed copy of their Agency Agreement. I agree to contact The Nanny Poppins Agency and request a copy of their Agency Agreement prior to contacting any applicants sent by/from the Agency.