Families seeking a caregiver should print the following document and complete and sign it,
We charge a $100.00 up front Non Refundable Registration Fee to start your search. (Please call us with Payment info)
Please email  the completed application to our office to begin a Caregiver search. (Once we receive your Application ,
we will give you a call to discuss your needs)

Nanny Brokers USA
(334)208-9877     
Please fax or email your application    email admin@nannybrokers.com


Family Application
(Please check which position you are seeking)                                                                                

Nanny __ Nanny/ Housekeeper_____Mother's Helper____Maid___
Elderly Caregiver___ House Manager____ Temp Care___Summer Care____ Other___

Live In ___ Live Out_____ After School ______
Full Time____ Part Time____ Interim______

                           

Date________ Date Care is needed____________

Family Name_________________________________________________________

Address_____________________________________________________________

City_____________________________State______________Zip_______________

Contact #'s    
Home_____________________Fax_____________
Mom's Cell_________________ Work _________________ Email______________________________
Dad's   Cell_________________ Work  ________________  Email______________________________

Mother's Profession ______________________________________
Father's Profession ______________________________________


Children's  Names & Ages:

1. ________________________________Age____ Sex________
2.________________________________ Age____Sex________
3.________________________________ Age____Sex________
4 .________________________________Age____Sex________
5.________________________________Age_____Sex________


Any medical conditions or concerns of the children
______________________________________________________


















Childcare Hours Needed:

Mon/  Start ________ Finish_______
Tues/ Start _________Finish_______
Wed/Start _________ Finish_______
Thurs/Start ________ Finish_______
Fri/ Start __________ Finish_______
Sat/ Start __________Finish_______
Sun/Start __________Finish_______

*Total hours per week ___________

Salary offered $________ Per hour  
Salary offered $ ________ Per week  for ______ Hours  (Before Deductions) Yes___ No____
Any Benefits offered? Yes_____ No_______ If Yes describe____________________________
Paid sick Days Yes_____ No_____
Paid Vacation Yes_____ No_____ If Yes how much___________________

Please describe the type person you feel will best work in your home, (age range , personality type)
______________________________________________________________________

_________ Light Housekeeping Duties include: pick up after activities/toys children's use, children's laundry,
cleaning up after children's meals ( loading /unloading dishwasher) , children's bedrooms kept neat  tidy,
vacuuming children's play areas and bedrooms .
_________ Moderate/Heavy Housekeeping Duties include: Change & launder bedding & clothes for the
family, clean bathrooms, vacuum, wash floors , dusting etc.
_________ Other Duties, Circle All That Apply: empty trash, bring trash/recycle to curb, check mail, feed pets.


Please Check all that pertain to your Family needs:

Car required____  Clean Driving record____
Car will be provided for trans of children_____  
CPR certified____ First Aide ______
Formal Training_____
2 Years childcare experience____
Non smoker____ Non Drinker_______
Age range of care giver______ To_______
Pets in the home?_____
Min one year assignment____
Temp assignment______
















For Live in Positions ONLY!!!
I will provide Separate Living quarters for the Caregiver Yes____ No____
I will provide a Bedroom and Private Bath for my Nanny? Yes_____ No_____
If no , please describe the living area for the Nanny.____________________________
_______________________________________________________________________
I will provide a car for the Nanny? Yes_____ No_____ Nanny Needs to own one____
If Yes,  Please describe how to be used, ( Personal & Work related use etc.)
____________________________________________________________

I am willing to have a Nanny re- locate here  from another State? Yes____ No___

If Yes, I understand I am responsible for providing a round trip airline or bus ticket for
transportation of the caregiver. Yes____

If the Nanny is to accompany us on a trip

The work schedule will be_______________________________________
Responsibilities will be__________________________________________________
We will pay meals, accommodations and expenses during work hours. Yes_____ No____

Nanny will be paid $______ per hour_________ or $________ Per Week

I
We look forward to be an important part of your home care needs, by
providing you with very responsible personnel. And excellent customer
service.



.
Sincerely
Cheryl La Fleur Collins

President

*Note*  It is VERY important to contact the caregivers Nanny Brokers selects for your Family within 24-48 hours after the
contact info has been given to you by the agency. Most caregivers are seeking to secure Immediate employment . They have
been told by the agency you will call them within this said time frame to preform a phone/personal face to face interview, if  you
do not contact the caregivers within this said time frame Nanny Brokers can not guarantee these Caregivers will not accept
other job offers from other Clients , and you could void your Family application with the Agency .

I understand and agree that NO Applicant will be Cleared to start employment  UNTIL The Agency gives me total
background clearance for safety  and security reasons.



________________________________________ Client signature    Date __________

________________________________________ Agency Signature  Date _________








** FOR OFFICE USE ONLY**
Nanny Hired:
Date Hired:
Fee's Paid in Full an Documents Returned by Due Date:         Yes        No
Date Search expires:
Total Placement Fee Charged  
Date trial period expires: