San Fernando Valley office

Please Fill out all relevant fields in the form.
Put as much text in each box as you like.
Include area codes with phone numbers.

Mother's Name
Occupation:
Office Phone:
Office Fax:
Email:
    
 
Father's Name:
Occupation:
Office Phone:
Office Fax:
Email:
    
 
 
Street
 
                   City
Address:
  
 
State
  
                    Zip
   
 
Home Phone:
Home Fax:
Children's Names:
Position
Start Date:
Weekly Salary:

Do you require: Live In  Live Out
Full Time Part time
If live in, are you providing private accommodations      Yes          No
   
Do you Plan on having any more children:      Yes          No
If yes, when?
Does anyone in the family smoke?      Yes          No
 
Do you require a nonsmoker?      Yes          No
   
Must the Nanny have a valid driver's license      Yes         No
   
Does the position require transporting to and from school, etc.?      Yes          No    
Do you have a car available for employee to transport children?      Yes         No    
Please give schedule requirements:    
Please describe duties:    
Any language other than English spoken
at home?   		   
Describe any circumstances or special needs that may impact your Nanny      
Do you observe any religious or dietary restrictions in your home? 
   
Are there any possible risks to the health and safety to the Nanny, inherent in this position?  
 
Will the family accept taking responsibility for taking care to protect the Nanny from physical, sexual, or psychological abuse by family members and or guests?   Yes   No
By submitting this form, I/We fully understand and accept misdescription or misrepresentation of aspects of the employment situation herein, or non payment of any fees, will make the Nannies Etc. Referral Agreement null and void. I/We acknowledge receipt of the Referral Agreement.

    

 

19625 Ventura Blvd #200, Tarzana CA 91356
Phone: (818) 342-5454 or (310) 696-0707
Fax: (818) 342-5656
E-mail: info@nanniesetc.com

 

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