Nanny/Housekeeper
Service Request
For Potential Clients 

(Fax To Your Nearest Location)

Newport Beach Fax: (949) 721 - 8946


Name:_____________________________
Title:______________________________
Street Address:______________________

State / Province:______________________
Zip / Postal Code:_____________________
Country:____________________________
Work Phone:________________________
Home Phone:________________________
FAX:______________________________
E-Mail:_____________________________
Cellular:____________________________
Request Live: IN or OUT (please circle one)
Date Needed:________________________
Weekly Salary?_______________________
Days Per Week:______________________
Size of House:________________________
How Did You Hear About Us?___________

Primary Duties (circle those that apply): Nanny Only | Nanny &Housekeeper | Housekeeper Only | Couples | Elderly Care
Cooking (circle those that apply): Simple | Gourmet | For Children Only
Pets:______________________________
Number of Children:__________________
Ages of Children:____________________
Knowledge of Swimming Pool? Yes | No
Car Required? Yes | No
Car Provided? Yes | No
Major Holidays Paid? Yes | No
Will Have Own Room? Yes | No
Will Have Own Bath? Yes | No

Additional Information or Comments:____
__________________________________
__________________________________
__________________________________

OC Nannies, Inc.

Newport Beach

Tel (949)721-0878
Fax (949) 721-8946

1303 Avocado Suite 190, 

Newport Beach, CA. 92660

 

e-mail: support@ocnannies.com