Nanny
Works Placement
Agency
Application for Temporary Nanny or Sitter
To protect the privacy of your information this
form is sent via secure transmission.
Your profession
or position at place of employment
Spouse's profession or position at place of employment
Child or children's name(s), date of birth, special needs (medical, transportation,
etc)
1.
2.
3.
4.
List Nanny's duties relating
to childcare
:
What pets are allowed indoors?
Will the nanny have any responsibility for pet care? Yes
No
If so, what?
Do you have a backyard swimming pool? Yes
No
(It is customary to compensate a nanny for the use
of her own car to run job-related errands or transport children)
If nanny’s vehicle is used for job related driving, will you reimburse
mileage? Yes
No
Are there any special circumstances in your household
that the nanny should know about?
(Such as: divorce, blended family, addiction or behavioral problems, house
for sale, religious beliefs, etc.)
Nanny Works will begin the search for candidates upon receipt of this completed form and payment of fees has been guaranteed. All fees are non-refundable. The membership fee is due when the interview is set up or services are provided. Please circle or check which MONTHLY membership you are interested in. There is a six month commitment with each one, however you have the option to cancel with 30 days notice after the commitment time.
Please mark each paragraph box to indicate you have
read and understood.
I,
(Please print your name) (hereinafter referred to as the “client” or “I”)
agree to use the services of Nanny Works (hereinafter referred
to as Nanny Works) in this referral of a childcare provider to work in my household.
Agree to Pay: In consideration for the aforementioned referral,
I will pay a referral fee (please see fee schedule) to Nanny Works.
This fee is contingent upon hiring a candidate that Nanny Works has
referred to me. Signing this contract in no way obligates
me to hire a candidate from Nanny Works.
I understand that there is an annual membership fee of $200 and agree
to pay it each year as long as I utilize the services of Nanny Works.
I understand, agree and accept that all candidates’ profiles and
files, which are received from Nanny Works, are the property of Nanny Works and the contents
are confidential. I agree that I will not disclose to anyone the names,
addresses, telephone numbers or vital information pertaining to any candidate.
I understand that I am not to contact any candidate directly for the
purpose of employment on a long-term or temporary basis without Nanny Works’s
knowledge. If, within one year of the date of the original referral I
offer long-term or temporary employment to a candidate that Nanny Works has referred
to me that states referral fee will be due Nanny Works. If I violate this provision
and any information contained in the file is disclosed to a third party
by me, and that third party hires the applicant, I agree to pay the placement
fee of said applicant. In the event that Nanny Works presses suit to enforce
this provision, then the prevailing party shall be reimbursed for court
cost and reasonable attorney fees.
Receipt of Fees: Should I hire an employee through Nanny Works I understand that
the referral fee is due when the offer is extended and accepted and it
is required that payment is received at that time. I understand that
I may prepay the referral fee by check or cash at the time of registration.
My new employee will not be permitted to start work until Nanny Works has received
the full fee. All fees paid are non-refundable. Membership fees are due
at or before the candidate interview process.
By marking and submitting this contract I agree to a six month commitment
with Nanny Works. After the commitment you have the option to
cancel at anytime with a 30 day notice and that can be mailed or emailed.
Background Screening: A professional
pre-employment screening firm performs Nanny Works’s searches. A nation-wide
criminal check is run on all nannies that are hired on a long-term
or short-term basis. These checks are important tools in screening
out undesirable care providers; however, no combination of background
checks is 100% fail-safe.
References: Nanny Works verifies the employment
history on each applicant.
Since collection can be difficult, time consuming and strain the relationship
between Nanny Works and its clients, Nanny Works asks for a Guarantee of Payment. By
signing this agreement I authorize Nanny Works to charge the agreed referral
fee to my American Express, MasterCard, Discover, or Visa credit card
account at the time of hire.
Client Acknowledgment and Release: Nanny Works is a referral and does not maintain
an employer/employee relationship with any candidate. Nanny Works will exercise
its best efforts in referring the most suitable candidates but cannot
make any guarantees; expressed or implied, regarding the performance
of the person referred to me and subsequently employed by me. There shall
be no additions, deletion, or modifications made to this contract. I
understand that Nanny Works does not have any control over the services provided
by the candidate.
I release and discharge forever Nanny Works, its respective
officers, directors, agents and employees from all actions, causes of
action, claims and demands for injuries, accidents, sickness, and damages
of whatsoever nature, whether known or unknown, which may be sustained
by me or my dependent arising out of the performance or nonperformance
of the candidate (my employee.) I, hereby agree to indemnify and
save harmless Nanny Works from all injuries, losses, damages and expenses, should
any claim, demand or suit be made by me on behalf of my child or children,
ward of parent(s).
I have read and I accept this agreement and I have retained a copy for
my personal records.