Loving Care Nanny Service

Family Application

Please check the type of nanny you are looking for:

Full-Time, Live-In
Full-Time, Live-Out
Part-Time
Latch-Key, After School
Summer

Parent Information:

Full Name(s):


Address:

Phone:

Father's Employer, Work Address, Work Phone:

 Father's Age:

Mother's Employer, Work Address, Work Phone:

 Mother's Age:

Do both parents reside at home?
Yes No
If, no, please state why:

Child Information:

Child's Name:
Boy Girl Age Grade Special Needs Yes No

Child's Name:
Boy Girl Age Grade Special Needs Yes No

Child's Name:
Boy Girl Age Grade Special Needs Yes No

Child's Name:
Boy Girl Age Grade Special Needs Yes No

If any child has special needs, please provide details here:

Other Family Information:

Number and types of pets:

Any language other than English spoken at home? Yes No
If yes, what language
and must your nanny speak that language? Yes No

Do you employ domestic help, such as a maid or cleaning service? Yes No

Please name two references (name, address, phone) who could speak on behalf
of your family's character and who will submit letters of recommendation if necessary.

SCHEDULING:

When would you like the nanny to start work?

What days and hours will the nanny work and what days will the nanny have off?
Sunday
Hours

Monday
Hours

Tuesday
Hours

Wednesday
Hours

Thursday
Hours

Friday
Hours

Saturday
Hours

Please select the accomodations you will provide if you have a LIVE-IN nanny:

Access To:

Telephone

TV

VCR

Stereo

Transportation:

Will you be providing the nanny with a car? Yes No
If yes, will the nanny be covered under your car insurance? Yes No
If no, would you reimburse the nanny 30 cents/mile for gas used in the nanny's car
for family business? Yes No

Will you need the nanny to travel with you? Yes No
If yes, where and how often:

General Information About the Nanny:

Do you prefer a female or male nanny?

Age:

18-25

25-30

30-40

40-50

Older

Must the nanny possess a valid driver's license? Yes No

What type of personality would you like the nanny to have?

Do you prefer a non-smoker?
Is smoking permitted off-duty? Yes No

Job Description:

What household tasks would you like the nanny to take care of:

For Child:

Bathing

Clean Child's Room

Babysit/Evenings

 

Driving

Clean Play Area

Babysit/Weekends

 

Meals

 

 

 

For Family:

Laundry

Vacuuming

Pickup

Other:

What abilities and skills do you desire the nanny to have?

Please describe any unusual requirements you may have.
Include any special needs your child(ren) require(s)?

Please state the salary range you are willing to pay?

What are your family's interests and activities?

Where did you hear about LOVING CARE NANNY SERVICES?

I/WE fully understand and accept that any misrepresentation of hours, duties,
or any other aspect of the employment situation herein, or nonpayment of any fees, will, at the
sole discretion of LOVING CARE NANNY SERVICES, make the L.C.N.S. FAMILY AGREEMENT
null and void and will require us take immediate action.

I/WE acknowledge receipt of the FAMILY AGREEMENT and agree to its terms and conditions. I/WE also understand that the registration fee is nonrefundable.

Signature of Parent: Date:
Signature of Parent: Date:
Email Address:         

For your immediate convenience, we will accept this form over the internet.
However, we require that you print this out and sign the signature areas on this page.

You can mail the signed application and fee to:

Loving Care Nanny Services, 4724 Windbreak Lane, Raleigh, NC 27616


HELPFUL TIPS TO HELP PRESERVE YOUR APPLICATION DATA & PREVENT DATA LOSS. *****Don't forget to save the form after you filled it out in case it doesn't send correctly. If you have a printer, it's best to print the document out to insure the preservation of your data. You may print it before submitting electronically (pressing the submit button or after submitting press the back button and then print the document. Any questions or problems, please call:
Loving Care Nanny Service - 919-261-8002
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