Nanny Employment Application

First Name:

Last Name:

Home Address:

Address Line 2:

City:

State:

Zipcode:

Home Phone:

Work Phone:

Mobile Phone:

Best Time to Call:

Email Address:

Emergency Contact Name:

Emergency Contact Phone Number:

What is your Gender? What is your Gender? Male Female

Do you have a driver's license? Do you have a driver's license? Yes No

Driver's License Number:

Driver's License State:

What is your age?

Start Date:

GEOGRAPHIC AREAS PREFERRED (Which areas do you want to work?) PLEASE LIST BELOW

Geographic Area 1:

Geographic Area 2:

Geographic Area 3:

Geographic Area 4:

Desired Salary:

Availability: Permanent Availability: Permanent Full-time Part-time Live-out Live-in Summer / Short-term

Hours Available: Temporary Hours Available: Temporary Week Days Week Nights Over Night Weekends

Please check all duties that you are willing to perform related to the care of children: Please check all duties that you are willing to perform related to the care of children: Laundry Bathing Reading to Children Feeding Preparing Meals Cleaning Age-Appropriate Activities Other (please describe below):

Describe Other:

Please check all duties that you are willing to perform that are non-child related: Please check all duties that you are willing to perform that are non-child related: Housekeeping Laundry Errands Cooking Other (please describe below):

Describe Other:

Do you have experience with infant care? Do you have experience with infant care? Yes No

Are you trained in Infant / Child CPR? Are you trained in Infant / Child CPR? Yes No

Are you willing to travel? Are you willing to travel? Yes No

Do you know First Aid? Do you know First Aid? Yes No

Are you willing to drive the children around? Are you willing to drive the children around? Yes No

If yes, do you have an insured car? If yes, do you have an insured car? Yes No

Car Make / Model

Can you swim? Can you swim? Yes No

Please describe your driving record:

Have you ever been arrested? Have you ever been arrested? Yes Now

If yes, please describe the circumstances of your arrest:

Have you ever been convicted of a crime? Have you ever been convicted of a crime? Yes Now

If yes, please describe the circumstances of your crime:

Would you work in a home with pets? Would you work in a home with pets? Yes No

Do you smoke? Do you smoke? Yes No

EMPLOYMENT HISTORY (NON-CHILDCARE RELATED) PLEASE LIST BELOW

Employer 1: LIST DETAILS BELOW

Business Name:

Supervisor's Name:

Business Phone Number:

May we contact? May we contact? Yes No

Business Address:

Address Line 2:

City:

State:

Zipcode:

Gross Salary (before taxes):

Start Date:

End Date:

Please describe your duties:

Reason for leaving:

Employer 2: LIST DETAILS BELOW

Business Name:

Supervisor's Name:

Business Phone Number:

May we contact? May we contact? Yes No

Business Address:

Address Line 2:

City:

State:

Zipcode:

Gross Salary (before taxes):

Start Date:

End Date:

Please describe your duties:

Reason for leaving:

Employer 3: LIST DETAILS BELOW

Business:

Supervisor's Name:

Business Phone Number:

May we contact? May we contact? Yes No

Business Address:

Address Line 2:

City:

State:

Zipcode:

Gross Salary (before taxes):

Start Date:

End Date:

Please describe your duties:

Reason for leaving:

CHILDCARE REFERENCES: PLEASE LIST DETAILS BELOW

Childcare Reference 1: LIST DETAILS BELOW

First Name:

Last Name:

Phone Number:

May we contact? May we contact? Yes No

Address:

Address 2:

City:

State:

Zipcode:

Gross Salary (before taxes):

Start Date:

End Date:

DESCRIBE CHILDREN BELOW

Child 1 Age:

Child 1 Gender: Child 1 Gender: Male Female

Child 2 Age:

Child 2 Gender: Child 2 Gender: Male Female

Child 3 Age:

Child 3 Gender: Child 3 Gender: Male Female

Child 4 Age:

Child 4 Gender: Child 4 Gender: Male Female

Please describe your duties:

Reason for leaving:

Childcare Reference 2: LIST DETAILS BELOW

First Name:

Last Name:

Phone Number:

May we contact? May we contact? Yes No

Address:

Address 2:

City:

State:

Zipcode:

Gross Salary (before taxes):

Start Date:

End Date:

DESCRIBE CHILDREN BELOW

Child 1 Age:

Child 1 Gender: Child 1 Gender: Male Female

Child 2 Age:

Child 2 Gender: Child 2 Gender: Male Female

Child 3 Age:

Child 3 Gender: Child 3 Gender: Male Female

Child 4 Age:

Child 4 Gender: Child 4 Gender: Male Female

Please describe your duties:

Reason for leaving:

Childcare Reference 3: LIST DETAILS BELOW

First Name:

Last Name:

Phone Number:

May we contact? May we contact? Yes No

Address:

Address 2:

City:

State:

Zipcode:

Gross Salary (before taxes):

Start Date:

End Date:

DESCRIBE CHILDREN BELOW

Child 1 Age:

Child 1 Gender: Child 1 Gender: Male Female

Child 2 Age:

Child 2 Gender: Child 2 Gender: Male Female

Child 3 Age:

Child 3 Gender: Child 3 Gender: Male Female

Child 4 Age:

Child 4 Gender: Child 4 Gender: Male Female

Please describe your duties:

Reason for leaving?

Why do you want to be a nanny?

What types of activities do you enjoy doing with children?

Please describe a typical day with a child you have been a care provide for:

Describe your personality:

What are your hobbies and interests?

What are your future goals?

Describe your discipline philosophy:

I am happiest when:

A bad day is when:

How did you hear about Metropolitan Nannies? (Required)

PERMANENT SERVICES CLIENT UNDERSTANDING AND RELEASE:

Understanding between parties:

Please Read!

1. Metropolitan Nannies, LLC. (“Metropolitan Nannies”) agrees to make its best effort to locate temporary child caregivers (“Caregivers”) upon request by the below-signed client (“Client”).

2. Rate: Client agrees to pay Caregivers directly for services rendered at least $15.00 per hour for 1-2 children and $1.00 per each additional child per hour, with a four-hour minimum.

3. Client understands that a non-refundable agency reservation fee will be charged to Client’s credit card upon Metropolitan Nannies’ confirming Client’s reservation for a Caregiver.

4. Client agrees to notify Metropolitan Nannies of any job cancellation and authorizes Metropolitan Nannies to automatically bill client’s credit card a cancellation fee of $25 if client cancels a job after confirmation by a Metropolitan Nannies’ employee. If client cancels a confirmed reservation within 24 hours of the scheduled visit, Client will be charged for four hours of the Caregiver’s time in addition to the agency reservation fee. Client acknowledges that jobs placed with less than 24 hours advanced notice will incur a $25 surcharge to be automatically billed to client’s credit card in addition to any other applicable fees.

5. Client understands that the services provided by all Metropolitan Nannies‘ Caregivers must be contracted through the Metropolitan Nannies office. Client further understands that the use of a Metropolitan Nannies‘ Caregiver or the referral of a Metropolitan Nannies‘ Caregiver to a third party, without arranging the visit through Metropolitan Nannies, is considered “theft of services” and will result in a charge of $1,000 in liquidated damages.

6. In the event that Client wishes to hire a Caregiver on a permanent basis, Metropolitan Nannies agrees to negotiate with Client in arriving at an acceptable placement fee. Metropolitan Nannies‘ standard placement fee for a Permanent Caregiver (“Nanny”) is the greater of 15% of the caregivers annual gross salary or $4,000 for a full-time placement (30 or more hours per week) is the greater of 15% of the caregivers annual gross salary or $2,500 for a part-time placement (less than 30 hours per week).

7. Client understands that Metropolitan Nannies‘ Caregivers are not employees of Metropolitan Nannies. Client understands that Client may be responsible for withholding and filing employment taxes for each calendar year in which the Caregiver’s payments exceed the limits set forth in the Internal Revenue Code. Social Security numbers of caregivers must be obtained directly from Caregivers.

8. Client agrees to indemnify, release and hold harmless Metropolitan Nannies, its agents, employees and officers for any and all claims relating to or arising out of the services provided in by Caregivers.

TRANSPORTATION WAIVER (OPTIONAL):

I hereby give my consent for a Metropolitan Nannies’ caregiver to transport my child(ren) in her or my automobile. I understand that Caregivers with Metropolitan Nannies are not employees of Metropolitan Nannies and that Metropolitan Nannies is making no representation or warranties relative to the Caregiver’s suitability to transport my child(ren). Metropolitan Nannies is in no way responsible for the safety of my child(ren) while being transported in Caregiver’s or my family’s automobile. I agree to indemnify, release and hold harmless Metropolitan Nannies, its agents, employees and officers for any and all claims including injury to Client’s car or child(ren) while being transported by a Metropolitan Nannies’ Caregiver.

MEDICAL RELEASE (OPTIONAL):

I hereby give my consent for a Metropolitan Nannies’ Caregiver to administer medication to my child(ren). I understand that Caregivers with Metropolitan Nannies are not medically trained. I agree to indemnify, release and hold harmless Metropolitan Nannies, its agents, employees and officers for any and all claims relating to a Caregiver’s administering of medication to my child(ren).

EMPLOYMENT APPLICATION

Nanny Employment Application

PERMANENT SERVICES CLIENT UNDERSTANDING AND RELEASE:

TRANSPORTATION WAIVER (OPTIONAL):

MEDICAL RELEASE (OPTIONAL):