| Name: * |
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| Home Phone: * |
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| Cell Phone: |
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| E-Mail: |
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| Fathers Work Place: |
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| Fathers Work Phone: |
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| Mothers Work Place: |
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| Mothers Work Phone: |
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| Complete Address: * |
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| Will Your Needs Be: |
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| Names and Ages of Children: * |
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| Do You Need: * |
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| For live in, please describe living arrangements for nanny: |
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| Hours Needed: * |
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| Days/Nights Needed: * |
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| Date you need nanny to start work: * |
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| Salary: (per week or per hour) * |
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| Benefits: Vacation pay, holidays, insurance, sick pay, etc. |
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| Do you have any pets? (please specify) |
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| Does anyone in your household smoke? |
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| Are there any special needs that your child/children may require? |
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| What skills and abilities are you looking for in a nanny? * |
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| Describe a typical day for your child/children and their nanny: |
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| What types of activities does your child/children enjoy? |
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| Will the nanny be driving your child/children anywhere? (if yes, please explain) |
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| Outside of childcare what other duties are you expecting from your nanny? |
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| What are the education requirements you expect in your nanny? |
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| Any other information you would like us to know. |
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