Need a Nanny Please complete all fields. Are you looking for Full- Time, Live-In Full- Time, Live-Out Part-Time Latch-Key, After School Summer Parent Information Full Name(s) for mother and/or father Home address Father's employer, work address, work phone Mother's employer, work address, work phone Mother's age Father's age Do both parents reside at home? If, no, please state why. Yes No Child Information How many children? First child Child's name Gender Boy Girl Age Grade level Special needs? Yes No Second child Child's name Gender Boy Girl Age Grade level Special needs? Yes No Please provide information for all additional children 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? If yes, what language? Must your nanny speak that language? Yes No Do you employ domestic help, such as a maid or cleaning service? Yes No When would you like the nanny to start work? What days will the nanny work? Monday Tuesday Wednesday Thursday Friday Saturday Sunday What days will the nanny have off? Monday Tuesday Wednesday Thursday Friday Saturday Sunday Will you need transportation for your child/ren? Yes No 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 cents/mile for gas used in the nanny's car for family business? Yes No Will you need the nanny to travel with you? If yes, where and how often? Yes No General Information about the Nanny Do you prefer a nanny of particular 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? What would be the nanny's job description? What household tasks would you like the nanny to take care of? Bathing Cleaning Babysit in the evenings Babysit weekends Laundry Pickup Cooking Vacuuming What abilities and skills do you desire the nanny to have? Please state the salary range you are willing to pay: Where did you hear about Loving Care Nanny Services? I/WE fully understand and accept that 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 LCNS FAMILY AGREEMENT null and void and will require that LCNS 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 non-refundable. Signature of parent Date Signature of parent Date Please type letters/symbols above. Name Email Phone Number Time's up
