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Full Name
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First
Last
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Address
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Street Address
Address Line 2
City
State / Province / Region
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Afghanistan
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Virgin Islands, U.S.
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Country
Nationality
(Required)
Type of Residence
(Required)
Private Home
Villa
Flat / Apartment
Number of Child(ren)
(Required)
Children's names, ages and gender
(Required)
Does the child have any allergies?
(Required)
Yes
No
please specify the type of allergy
(Required)
food, medicine, environment, others
Does the child have Special Educational Needs (SEN) or disabilities?
(Required)
Yes
No
Other
Does the child have a physical disability or motor impairment?
(Required)
Yes
No
Other
Does the child have any speech and language delays?
(Required)
Yes
No
Other
Does the child exhibit challenging behaviour (e.g. hyperactivity or aggression)?
(Required)
Yes
No
Other
Does the child have learning difficulties?
(Required)
Yes
No
Other
Does the child show signs of autism (ASD) or social communication difficulties?
(Required)
Yes
No
Other
Does the child have a visual or hearing impairment?
(Required)
Yes
No
Other
Is there any developmental delay (e.g. in motor skills or social skills)?
(Required)
Yes
No
Other
Does the child suffer from emotional issues, such as anxiety or depression?
(Required)
Yes
No
Other
Does the child have a specific milk allergy or intolerance?
(Required)
Yes
No
Other
Does the child display signs of hyperactivity/ADHD?
(Required)
Yes
No
Other
Special Notes
(Required)
Position Title
(Required)
Baby Nanny Live-in
Baby Nanny Live-out
Toddler Nanny Live-in
Toddler Nanny Live-out
Live-in Facility
(Required)
Private Room
Shared Room
Not Applicable
Working Schedule:
(Required)
Full-time
Part-time
Shift
Working Hours
(Required)
Start Date
(Required)
DD slash MM slash YYYY
Contract Duration
(Required)
Job Description and Responsibilities for the Baby Nanny
(Required)
Bathing the baby
giving the baby milk (bottle-feeding)
Preparing and cooking baby food or weaning meals
Managing the feeding and weaning schedule
Feeding the baby solids
Washing and sterilising bottles
Washing the baby’s clothes (doing the baby’s laundry)
Ironing the baby’s clothes
Changing nappies
Cleaning baby equipment for outings (e.g. pram, travel bag)
Ironing baby or toddler clothes
Cleaning the nursery (baby’s room)
Settling the baby to sleep
Cleaning the baby’s toys
Cleaning the baby’s bathroom
Job Description and Responsibilities for the Toddler Nanny
(Required)
Bathing the toddler
Giving the toddler milk
Grocery shopping for the child’s needs (including food)
Creating a meal plan / menu for the child
Cooking the child’s meals
Preparing the child’s food (Plating up/serving)
Feeding the child / Helping the child eat
Washing the child’s feeding equipment and crockery
Sterilising the child’s feeding equipment
Washing the child’s clothes
Ironing the child’s clothes
Changing nappies (or assisting with potty training)
Packing the child’s bag for outings
Taking the toddler to school/nursery
Preparing the toddler’s packed lunch for school
Accompanying the child to school (Chaperoning)
Helping the child with learning activities/homework
Taking the child to clubs or extra-curricular classes (e.g. swimming, music)
Cleaning the child’s bedroom
Settling the child to sleep / Putting the child to bed
Cleaning the child’s bathroom
Playing with the child (or Engaging the child in play)
Is the nanny expected to prepare meals for the adults?
(Required)
Yes
No
Other Responsibilities
Candidate Preference Level
(Required)
Standard – Basic child care experience, suitable for routine daily support.
Experienced – Higher level experience, more independent and confident.
Signature – Expert-level child care professional with certification and advanced experience.
Number of Adults in the House
(Required)
Pets at Home
(Required)
Yes
No
CCTV in Use
(Required)
Yes
No
Monthly Salary Range
(Required)
Weekly Day Off
(Required)
Overtime Policy
(Required)
Additional Benefits
(Required)
Important Notes
(Required)
Please describe expectations, routines, discipline approach, screen time rules, health considerations, and household boundaries
Agreement & Confirmation
(Required)
By submitting this form, I confirm that all information provided is accurate and agree to ValivingBali’s policies, procedures, and Commitment Agreement.
Signature
(Required)
