Please complete the following Nanny application and the Nanny agreement and return them via US Mail (to: 2131 N. Collins #433 PMB #414, Arlington, TX 76011)
On a separate piece of paper, or in an E-mail, please answer the following questions:
1. Talk about your childcare experience and why you enjoy being a nanny?
2. What are you interested in and what sort of lifestyle do you have?
3. Have you ever experienced being away from home? Please write about where you were and how long you were away?
4. How do you describe your personality?
Nanny Application and agreement:
Name: ___________________________________________ Date:_______________
Work Phone:_____________________ Home Phone: __________________________
Email Address:_______________________________
Current Address: Street: _______________________ City: _________________ Zip:_____
Are you at least 18 yrs. old:______________Social Security #: ______________________
Driving/ Personal Habits:
Valid Diver's License:______________ State:_____________________________
License #:__________________________________________________________
Number of accidents/moving violations in which you were a driver in the last 3 yrs:___________
Have you ever been convicted of a crime:_________________ Explain:_____________________________________________________________________
Do you drive a stick shift?__________ Can you bring a car?_______________________________
Do you smoke?______ Do you take drugs?______ Do you drink alcoholic beverages?___________
Dietary restrictions: __________________________________________________________
Child Care Experience:
Live-in Nanny:________ Live-out Nanny:__________ Mother's Helper:____________
Please describe your experience as a nanny or mother's helper or babysitter _____________________________________________________________________________
______________________________________________________________________________
Cared for nursing baby____ Prepared formula ______ Gave solid foods to baby ____
Provided 24 hr. childcare________ Gave medications ___________
Helped toilet train a toddler________ Taught child to swim________
Cared for ill children__________ Please explain_________________________
Experience with special needs children ________________________
Please explain ________________________________
Student Teaching:_________ Teaching:_________ Camp Counselor:_________ Babysitting:________ Childcare Courses:____________________ CPR:_______
Brought up own children:________ Other:___________
Experience by age of children: Newborn: ___________ 6-24 months:__________
2-5 yrs.:_________ 6-12 yrs.:___________ Teenagers: ___________
Health:
How is your general health?____________________________________________
What is your energy level?_____________________________________________
Do you take any prescription medications?________ What for?_______________
Allergies:____________ Psychological problems?:_________________________
Are you physically able to do this job?___________________________________
Education/Interests:
Highest level of education:_______________________________________ School/College:____________ Do you swim?____________ How well?_________
Special interests:____________________________________________
Do you like pets?____________
Hobbies:_________________________________________________________________
Housekeeping:
General housekeeping:____________ Children's only:_____________
Cooking ability:____________
Dog walking?___________________
Past employment:
From To Family/Company Telephone Supervisor
________ _______ _______________________ _____________ _____________________
________ _______ _______________________ _____________ _____________________
________ _______ _______________________ _____________ _____________________
Personal References:
Please provide a personal reference who has known you for at least three years. Please do not list a relative :
Name:__________________ Relationship:_________________ Phone:____________
List three childcare references that are not relatives within the past three years:
Name: Phone: Age of Children:
____________________________ _________________________ _____________________
____________________________ _________________________ _____________________
____________________________ _________________________ _____________________
Permanent address:
Permanent address:____________________________________________________
Permanent phone:__________________________
Authorization:
I __________________________________acknowledge that you have advised me that you may request a reference check which may include information on my character, general reputation, education, personal characteristics, driving record, police record, and past employment. I hereby authorize you to obtain such a report. I acknowledge that I have read and understand this statement and all statements made, and the information provided on the employment application, of which this is a part, are true to the best of my knowledge. I agree to release and promise to hold NanniesNet Agency Inc. harmless for any act of the employer. I also agree to hold NanniesNet Agency Inc. harmless of any claim as a result of the placement.
Applicant's signature:____________________________Date:_______________
Agreement between (Nanny, herein referred to as "Nanny" or "I"): _____________________ and NanniesNet Agency Inc., a licensed and bonded employment agency in the State of Texas.
NanniesNet Agency Inc. is acting solely as a referral agent and at no time will be the employer. The Nanny is under no obligation to accept any referral to or a job from anyone NanniesNet Agency Inc. refers the Nanny to.
I hereby certify that my claimed identity is genuine and true and I also certify that all the information in the application, essays and additional information given to NanniesNet Agency Inc. by added means is true in all respects.
I hereby relinquish all claims or possible liability from NanniesNet Agency Inc. At no time will NanniesNet Agency Inc. be held responsible for any damage or loss resulting from employment from a NanniesNet Agency Inc. referral, including any acts of commission or omission on my part or the part of the employer family. I also agree that NanniesNet Agency Inc. will not be held liable for the reimbursement of any fees arising from traveling to or from the set job or any possible court costs or lawyer fees stemming from any claim that may be made by any person.
I understand that I must inform NanniesNet Agency Inc. of any contracts or job offers that may come about in the course of my job search including the acceptance of a position. NanniesNet Agency Inc. is not obligated to find me a position and will not be held responsible if an employment is unsuccessful.
I agree to keep all information given to me about prospective employers confidential and will continue to keep that confidential at all times in respect for the families' privacy.
I am aware that I am responsible for the travel expenses and travel arrangements to relocate to the said employment and will make my own agreement with my employer for reimbursement or other compensation.
I understand that I am not required to pay a fee of any kind for the referral services of NanniesNet Agency Inc. I understand that the NanniesNet Agency's referral fee is the obligation of my employer. I am aware that there is a contractual agreement between NanniesNet Agency Inc. and my employer and understand that I may not arrive at the employer's home until such conditions as set in the agreement between NanniesNet Agency Inc. and my employer.
I understand that I am being asked to make at least a ________ month commitment to which ever family I decide to be placed with and am willing to do so. I can start work on this date: ________ and I must complete work by this date: _________.
I agree to follow the rules laid down by the American Arbitration Association stating that any problems or breeches of contract arising from this agreement must be settled by arbitration and any judgment made by the arbitrators may be entered in any court having jurisdiction thereof.
I understand that NanniesNet Agency Inc. and my employer will rely on information which I provide on my application, forms provided by NanniesNet Agency Inc. and other records and/or statements which I may provide. I give permission to NanniesNet Agency Inc. and any prospective employer to verify and use the information for employment purposes which I provide during an interview or in writing. I agree that NanniesNet Agency Inc. may cancel its agreement to assist me in finding employment and/or that my employer may dismiss me immediately if any part of the information is not true.
I understand that nothing in this contract is intended to guarantee that NanniesNet Agency Inc. will find me a suitable position. If I accept a position as a result of a referral from NanniesNet Agency Inc. and the job is unsuccessful, I understand that NanniesNet Agency Inc. is not required to assist me in finding another job or to reimburse me for any expenses I may incur should I voluntarily or involuntarily leave my job.
I have read and understand all of the foregoing provisions of this contract and I confirm my agreement with all that is contained in the contract by signing my signature below:
Signature____________________________________ Date ______________________
