| Today's Date: |
How Did You Hear About Us?
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| Desired Start Date: |
May We Call Your Home?
Yes
No |
| Contact Name - Last: |
First:
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| Phones - Work: |
Home:
Cell:
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| Fax: |
Best number to reach you:
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| Spouse Name - Last: |
First:
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| Phones - Work: |
Home:
Cell:
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| Email Address: |
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| Home Address: |
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| City: |
State:
Zip:
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| Area of Town: |
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| Your Profession: |
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| Your Employer: |
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| Spouse's Profession: |
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| Spouse's Employer: |
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| (This information is helpful because your nanny will want to know a bit about you too!) |
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| LIVE OUT ONLY
LIVE IN
EITHER LIVE IN OR LIVE OUT
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Accomodations
(Live-In Only): |
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| Salary is negotiable based upon qualifications:
Yes
No |
| Please note it is customary practice for a nanny to earn a minimum of 2 weeks paid vacation and to earn the full salary, if by no fault of her/his own, she/he is given a day or days off. |
| Paid Vacation Benefits:
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| Will Nanny be paid for time off if you don't need her?
Yes
No |
| Other benefits or conditions of employment:
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| Will you be deducting FUTA/FICA payroll taxes?
Yes
No |
| JOB DESCRIPTION AND DUTIES (Nannies are expected to care for all child related tasks - children's: laundry, bedrooms, play area, etc.) |
| Will employee have housekeeping duties beyond child care duties?
Yes
No |
| Housekeeping: |
Light
(Pickup common areas only, laundry, and dishes) |
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Full
(Family's living areas, bathrooms, bedrooms - full cleaning) |
| If full Housekeeping will be required: |
| Approximate Home Square Footage:
Number of Stories:
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| Number of Bedrooms:
Number of Bathrooms:
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| Detail of Housekeeping Duties:
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| Will Cooking Be Required?
Yes
No Details:
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Are there any special circusmstancesthat employee should be aware of?
(Such as blended family, single parent, same sex parents, addiction, behavioral problems, therapy, divorce proceedings, abusive parent issues, religious beliefs or practices, care of elderly or infirmed, special diet, health problems or allergies, etc.)
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| QUALIFICATIONS: |
| "On the Job" Driving:
Yes
No |
| Will a vehicle be provided for employee's use?
Yes
No |
| If employee's vehicle is used, will you pay mileage?
Yes
No |
| Do you have a backyard swimming pool?
Yes
No |
| Will employee be required to swim with children?
Yes
No |
| Will employee be asked to help with homework?
Yes
No |
| Other:
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Thank you for the trust you are placing in us and we look forward to being of assistance. The Nanny Connection will begin the search for candidates upon receipt of this completed form, the signed Client/Agency Agreement and payment of the search fee ($75). Fees are
non-refundable. |
Client/Agency Contract
Nanny Connection |
I, (please print your name) (hereinafter referred to as the “client” or “I”) agree to use the services of Nanny Connection, (hereinafter referred to as NC) in the referral of a childcare, eldercare provider or housekeeper, (hereinafter referred to as an “employee” “applicant” “nanny” or “candidate”) in my household.
Agree to Pay: In consideration for the aforementioned referral, I will pay a referral fee to NC. This fee is contingent upon my hiring a candidate that NC has referred to me. I understand, agree and accept that all candidates’ profiles and files of applicants, which are received from NC, are the property of NC and the contents are confidential. I agree that I will not disclose to anyone the names, addresses and/or telephone numbers of any candidate. If, within one year of the date of the original referral I offer employment to a candidate that NC has referred to me the full placement fee will be due to NC. 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 NC presses suit to enforce this provision, then the prevailing party shall be reimbursed for court costs and reasonable attorney fees.
Receipt of Fees: Should I hire an employee through NC I understand that referral fees are 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 or authorize the use of my credit card number as payment for placement. My new employee will not be permitted to start work until NC has received full fees. All fees paid are non-refundable. Referral fees are not deposited until I agree to employ the candidate that NC referred to me.
Replacement (this applies to long term, full time, (35 hours or more) live out placements only): Should employee replacement become necessary within the first ninety (90) calendar days immediately following my employee’s first day of employment, NC will refer additional candidates to me at no additional charge. I may hire one (1) candidate without payment of an additional fee. I must notify NC within seven (7) days of the last day worked or when the decision has been made to terminate, or when my employee has given notice of their intent to leave their position. Written notice is required and should include the reason for termination and the date termination is/or will be effective. If subsequent replacements (this applies to full time live out placements only) are needed during the 90-day period or for the twelve (12) months following the original employee’s start date, NC agrees to charge a (50%) reduced placement fee. If notification requirements are not met, or if NC learns that the employee was mistreated, or the employee’s duties changed in a manner unacceptable to the employee or that the employee was not paid the agreed upon wage in a timely manner, the provisions of the Replacement Policy will be null and void. NC understands the urgency that arises when a replacement is needed and therefore treats replacements with the highest priority. NC will begin the search for new candidates immediately upon receipt of proper notification. NC will discontinue the search for a replacement if I do not find a suitable replacement because I have not made myself available to interview potential employees within thirty-days. I understand that the time it will take to find a replacement is unpredictable.
Background Screening: A written background search report will be provided when an offer of long-term employment has been made to a particular applicant that NC has referred. The report will include a multi-state criminal court records search, a Bexar County felony and misdemeanor search, an identity verification report, a social security trace, a sex offender search, a wants and warrants search and a driving history. A professional pre-employment screening firm performs NC’s searches and are available within 48 hours. A multi-state 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. If the background report is not clear, NC will call and notify me. If I find the candidate unacceptable based on the information reported I am allowed to retract my offer of employment and prepaid fees will be refunded.
Hiring: I agree to notify NC as to whom I would like to hire, what the start date will be and the starting salary (based on gross wages) that is agreed upon. Upon the applicant’s acceptance of the offer and receipt of the referral fee, NC will then run the above described background screening. If time is an issue, I may make the offer of employment directly to the applicant, but must notify NC within twenty-four (24) hours of the offer and acceptance. Fax, voice mail and e-mail are available twenty-four (24) hours a day. NC doesn’t initiate the background search until an applicant has accepted a job offer. Background screening reports are normally available on the same business day NC is notified.
References: NC will provide me with an employment history on each applicant. The written references will include the applicant’s past employers’ names and the dates of employment and the comments they made in regard to the candidate. The references’ phone numbers will be given to me after I have expressed interest in employing the candidate.
NC will begin a search only if the information below is completed and a guarantee of payment by credit card, cash or check is accompanying this contract.
Guarantee of Payment: By submitting this agreement I authorize NC to charge the agreed referral fee to my American Express, MasterCard or Visa credit card account if I hire an applicant that NC has referred to me. If I am not comfortable giving out the required credit card information, than please click here to download the Family Registration form, fill it out and send it, along with a separate check for the full amount of the search fee and the placement fee (6% of the anticipated annualized salary.) You can also make out two separate checks for these fees. A fee will not be due unless the candidate has been hired by me and I will be notified that NC will be processing the charge to my account. No charge will be made without NC attempting to notify me.
I understand the above statement regarding Guarantee of Payment. I authorize Nanny Connection to charge my credit card account if I hire an applicant from Nanny Connection. |
PLEASE CHARGE MY SEARCH & REFERRAL FEE TO:
(Required information - You are on a secure server to protect you)
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| Credit Card: |
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Card No.: |
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| Name on Card: |
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Verification Code: |
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| Exp. Date: |
(Eg:MM/YY) |
I understand and agree that if I employ an applicant referred to me by Nanny Connection, or I refer that candidate to a third party and the candidate is hired by that person I will be obligated to pay the referral fee. In addition, I further understand that in the event that Nanny Connection must seek collection of fees or any portion thereof, I shall be responsible to pay all costs of such collection, including court costs and reasonable attorney’s fees. I also understand that the majority of work done by Nanny Connection is done in San Antonio, Bexar County, Texas and that in connection with this contract I stipulate and agree that any litigation, which arises from this contract, will be placed in the jurisdiction limits of San Antonio, Bexar County, Texas.
Client Acknowledgment and Release: NC is a referral service and does not maintain an employer/employee relationship with any candidate. Accordingly I accept that it is my responsibility to interview any candidates selected for referral by NC, to contact references or prior employers and to thoroughly review all of the information made available by NC concerning the candidate. NC 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. I will be provided with a written Client/Agency/Employee Agreement at the time I hire a long term, full time, live out employee and must sign this form and return a copy to NC. There shall be no additions, deletions or modifications made to this contract. NC strongly encourages my employee and I to both sign and date a job description/employment agreement specifying the condition of employment before employment commences. If NC does not receive a copy of this agreement NC will become sole judge of employer/employee disputes as it pertains to employee replacement. The Replacement Policy will be in effect only if NC receives copies of these documents within the first two weeks of the candidate’s employment. I understand that NC does not have any control over the services provided by the candidate (my employee) to the child or the adult. NC does not act as the supervisor of my employee and it is my responsibility to supervise the activities of the candidate while I employ him or her.
I release and discharge forever Nanny Connection, 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 NC from all injuries, losses, damages and expenses, should any claim, demand or suit be made by me on behalf of my child, children, ward(s) or parent(s).
I have read and I accept this agreement and I have retained a copy for my personal records (click on the SUBMIT/PRINT button). I understand that clicking on the SUBMIT button and submitting this form and contract is the equivalent of signing this document. |
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