Client Placement Profiles | Nannies Who Care

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Family Info

Mothers First Name:

Mothers Last Name:

Mothers Address1:

Mothers Address2:

Mothers City:

Mothers State:

Mothers Zip:

GEO Area Nanny is needed:

Mothers Home Phone :

Mothers Cell Phone:

Mothers Occupation:

Mothers Business Name:

Mothers Business Address1:

Mothers Business Address2:

Mothers Business City:

Mothers Business State:

Mothers Business Zip:

Mothers Business Phone :

Mothers Business Email:

Fathers First Name:

Fathers Last Name:

Fathers Address1:

Fathers Address2:

Fathers City:

Fathers State:

Fathers Zip:

Fathers Home Phone :

Fathers Cell Phone:

Fathers Occupation:

Fathers Business Name:

Fathers Business Address1:

Fathers Business Address2:

Fathers Business City:

Fathers Business State:

Fathers Business Zip:

Fathers Business Phone :

Fathers Business Email:

Contact Name:

Marital Status:

If separated or divorced, who has custody?:

What are visitation rights?:

Are there any other adults living with you?:

If Yes, how many and their relation to you?:

Specific Religious Requirements :

What is the approximate square footage of your home?:

Describe your family personality traits:

Do you have any pets?:

If Yes, indoor or outdoor:

What type(s) of pets and how many?:

How often do you travel. Does nanny need to stay overnight? :

How did you hear about us?:

Family References

Reference 1

Reference Name:

Reference Address:

Reference City:

Reference State:

Reference Zip:

Reference Phone:

>Reference Email:

Reference Relationship :

Reference 2

Reference Name:

Reference Address:

Reference City:

Reference State:

Reference Zip:

Reference Phone:

>Reference Email:

Reference Relationship :

Children Info

Child Name:

Child Birth Date:

Child Gender:

Special Needs:

Family Requirements

Live In?:

Hours Desired:

Full Time?:

Part Time?:

On Call?:

Nights/Weekends?:

Need Bilingual?:

Languages Needed :

Newborn Specialist :

Autism/Special needs:

Sunday Hours:

Monday Hours:

Tuesday Hours:

Wednesday Hours:

Thursday Hours:

Friday Hours:

Saturday Hours:

Start Date :

Overtime?:

Is Over night ever required?:

Smoking ok?:

Pet Care?:

Nanny can bring child?:

Pickup Children?:

Errands?:

Party Server?:

Does nanny need car? :

Laundry?:

Cooking?:

Other Duties info:

Expected Salary:

Overtime Comp:

Benefits info:

Perfect Nanny desc:

Additional Comments: