Position:

Hours of work per week:

Start time:

Finish time:

Evening care required?: Yes No

How often?:

Days off:

Weekly salary: $

Hourly rate: $

Part time rate: $

Overtime pay: $

Overnight: $

Benefits & Perks: (ie; health insurance, phone allowance, cable, travel with family, tuition, paid vacation, holidays off, bonus, etc.)

Please list all the qualities you are looking for in a Nanny:

What accomodations will you provide your Nanny? (ie; bedroom, bathroom, private or shared bath, tv, phone)

Are there smokers in the home?: Yes No

Do you have pets?: Yes No          If yes, please specify:

Please list caregiver duties & responsibilites regarding your children (ie childcare activities, transportation, etc.)

Please list housekeeping duties:

Please list any other information about your family that may help us in making a successful placement: