Today's Date (required):

Name (required)

Home Address (required): Please include STREET, CITY, STATE and ZIP:

Home Phone (required):

Work Phone:

Cell Phone (required):

Email (required):

Social Security number:

Drivers License number: State:

Preferred Areas for Employment:

Are you eligible to work in the U.S.?  yes no

How were you referred to Elite Nannies and sitters?

Type of position you are seeking (check as many as apply):

Permanent: ---YesNo Temporary: ---YesNo Full-time: ---YesNo Part-Time: ---YesNo Days: ---YesNo Evenings: ---YesNo
Weekends: ---YesNo Live-In: ---YesNo 24 hour/Overnight: ---YesNo Summer: ---YesNo Work around school schedule: ---YesNo

Preferred Age of children (check as many as apply):

Newborn (0 -3 mo): ---YesNo Infant (3-12 mo): ---YesNo Toddler (12 mo - 3 yrs): ---YesNo Preschool (3 yrs -5 yrs): ---YesNo
Elementary (5 yrs +): ---YesNo

Please check all that you are willing to care for (check as many as apply):

Physical Disabilities: ---YesNo Physical Disabilities w/ Medical Care: ---YesNo Learning Disabilities: ---YesNo Behavioral Disorders: ---YesNo Multiples: ---YesNo

Preferred number of children:

Days/ Hours Available:

Do you have an insured, reliable vehicle to transport children?  yes no

Are you willing to transport children?  yes no

In case of emergency, please contact (name & phone number):

Relationship to you:

EDUCATION:

High School: Dates: City: State: Last grade Completed: ---123456789101112
Area of Study: Degree:

College: Dates: City: State: Last grade Completed: ---123456
Area of Study: Degree:

College: Dates: City: State: Last grade Completed: ---123456
Area of Study: Degree:

Trade School: Dates: City: State: Last grade Completed: ---123456

Area of Study: Degree:

Other Courses:

Have you taken Child Development courses?  yes no

Have you taken any Education classes?  yes no

Have you taken any Home Economic classes?  yes no

Have you had CPR?  yes no
Expiration date:

Have you had 1st Aid?  yes no
Expiration date:

CHARACTER REFERENCES (People who know you well. NOT child care references):

1. Name: Address(city & state):
Phone: Length of Relationship
Nature of Relationship:

2. Name: Address(city & state):
Phone: Length of Relationship
Nature of Relationship:

3. Name: Address(city & state):
Phone: Length of Relationship
Nature of Relationship:

PERMANENT CHILD CARE EXPERIENCE (Please list jobs of 3 months or more, i.e. nanny, day care, teaching, etc.):

1. Dates(month & year): Employer & Supervisor: Address(city & state): Phone:
Number of children: Age of children:
Reason for leaving: Gross salary:

2. Dates(month & year): Employer & Supervisor: Address(city & state): Phone:
Number of children: Age of children:
Reason for leaving: Gross salary:

3. Dates(month & year): Employer & Supervisor: Address(city & state): Phone:
Number of children: Age of children:
Reason for leaving: Gross salary:

4. Dates(month & year): Employer & Supervisor: Address(city & state): Phone:
Number of children: Age of children:
Reason for leaving: Gross salary:

BABYSITTING EXPERIENCE (Please list babysitting experience of 3 months or more, NOT including family members):

1. Dates(month & year): Parents Name:
Address(city & state): Phone:
Number of children: Age of children:

2. Dates(month & year): Parents Name:
Address(city & state): Phone:
Number of children: Age of children:

3. Dates(month & year): Parents Name:
Address(city & state): Phone:
Number of children: Age of children:

4. Dates(month & year): Parents Name:
Address(city & state): Phone:
Number of children: Age of children:

5. Dates(month & year): Parents Name:
Address(city & state): Phone:
Number of children: Age of children:

VOLUNTEER WORK (Please list dates adn organizations):

OTHER WORK EXPERIENCE (Please list your most recent jobs NOT in the child care field):

1. Dates(month & year): Company: Supervisor/Reference: Address(city & state): Phone: Reason for leaving:

2. Dates(month & year): Company: Supervisor/Reference: Address(city & state): Phone: Reason for leaving:

3. Dates(month & year): Company: Supervisor/Reference: Address(city & state): Phone: Reason for leaving:

4. Dates(month & year): Company: Supervisor/Reference: Address(city & state): Phone: Reason for leaving:

5. Dates(month & year): Company: Supervisor/Reference: Address(city & state): Phone: Reason for leaving:

Club, Professional Associations, Organizational Affiliations:

Please answer HALF of the following questions as completely as possible.

1. What types of stimulating activities can you do with a 6 month old to promote growth and development?

2. What activities would you include in a typical day if you were caring for a two-year-old?

What types of things would you be teaching this child?

3. What would you fix a two-year-old for lunch?

4. What would you do if two children ages 5 and 3 began fighting over a toy?

5. What would you do if a child felt hot and seemed sick when he woke up from a nap?

6. How would you handle a child who is going through a biting stage?

7. How would you handle a temper tantrums?

8. How do you handle a child who screams when the parents get ready to leave?

9. List some reasons why a baby might cry:

If you can not find anything wrong, what are some ways to soothe a crying baby?

11. Do you have experience with special needs children?  yes no

Please describe:

12. Please describe your child care philosophy regarding discipline. What methods do you use with specific ages?

13. What would you say to a 3 year old who tells you he hates you?

14. How often should a newborn’s diaper be checked?

PERSONAL ESSAY: Why do you feel you would make a good nanny? Please include special skills (foreign language, sign language, life guard, etc) activities you like to do, special interests, and details about your personality.

Authorization:

I understand that the information on this application has been requested for the purpose of evaluating my qualifications for employment by parents, as a child care provider. I also understand that I am not, and will not be an employee of Elite Nannies and Sitters.
I hereby authorize you to request reference checks which may include information on my character, education, driving record, police record, past employment, previous addresses, and social security number.
To the best of my knowledge, the information on this application is true. I understand that misrepresentation or omission of facts in connection with the information provided may be sufficient cause for dismissal wherever discovered.
I permit Elite Nannies and Sitters to show this application and all references to parents as a part of the evaluation process.
I agree to release, and hold Elite Nannies and Sitters harmless for any act of the employer. I also agree to hold Elite Nannies and Sitters harmless of any claim as a result of the placement.

NOTICE: We will require a criminal background check, sex offender registry and Social Security verification. We will also require driving history and further screening requested by a family. DISCLAIMER: There is no guarantee of employment. We reserve the right to reject any candidate.

I have read,understand and agree to the terms of the application.

 Yes No

Disclosure:

This document serves solely as a clear and conspicuous written disclosure as required by the Federal Fair Credit Reporting Act set forth in section 604 (b) to the Candidate that previous employment, education, social security, credit, motor vehicle report and criminal background check may be obtained for the purpose of this “Application” only.

By agreeing below, the “Applicant” acknowledges that Elite Nannies and Sitters, LLC has made this disclosure.

I have read and understand the terms of the agreement.

 Agree Disagree

Today's Date (required):

Mother's Name (required)

Occupation:

Place of Employment:

Work Phone:

Cell Phone:

Email (required):

Father's Name (required)

Occupation:

Place of Employment:

Work Phone:

Cell Phone:

Email (required):

Home Address (required): Please include STREET, CITY, STATE and ZIP:

Home Phone (required):

Emergency phone contact other then parents (required):

Type of delivery planned: ---VaginalCesarean SectionUnknow

Due Date (required): Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---200920102011201220132014201520162017201820192020

Scheuled Cesarean Section date: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---200920102011201220132014201520162017201820192020

Gender (if known): ---MaleFemale

Adoption arrival date: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---200920102011201220132014201520162017201820192020

Age of adoped infant: ---1 month2 months3 months4 months5 months6 months

Gender: ---MaleFemale

If it is a male infant will he be circumcised?  yes no

Hospital Name:

Hospital Phone:

OB-GYN Name:

Do you work outside of the home?  yes no

If yes, do you plan to return after the birth?  yes no

If so how long do you plan to take off?

Will your partner be taking any time off after the baby is born?  yes no

If so how long?

Please list any pets:

Will you need help with pets?  yes no

Will any other family members or friends be staying in your home (e.g. grandparents)?  yes no

Will they be there when care is being provided?  yes no

Is this your first child?  yes no

If no please describe other children:

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender: ---MaleFemale

Diapers:  yes no

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender: ---MaleFemale

Diapers:  yes no

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender: ---MaleFemale

Diapers:  yes no

Please add anything that you feel is important for us to know concerning you and your family (allergies, special instructions, etc.).

Nanny Start date: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---200920102011201220132014201520162017201820192020

Duration of care in week's: ---1234567891011121314151617181920212223242526 Number of nights per week: ---1234567

Preferred nights:

Night one: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday

Night two: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday

Night three: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday

Night four: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday

Night five: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday

Night six: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday

Night seven: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday

Preferred hours (9pm-6am or 10pm-7am): Time: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm To: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm

Are you going to try brestfeeding?  yes no

Would you like caregiver to wake you to breastfeed, or would you like her to bottle feed the baby?

Please describe what services you anticipate needing most from the newborn overnight caregiver:

How did you hear about Elite's Newborn Care Program?

Would you like more information regarding other Elite Nannies and Sitters services (click all that apply)?

Nanny Placement Service: ---YesNo Party Helpers: ---YesNo House and Pet Sitters: ---YesNo Babysitters: ---YesNo

Purpose and Terms of Agreement

Employer desires to hire a Newborn Care Provider (hereinafter “NCP”). ELITE NANNIES AND SITTERS, LLC (hereinafter "ELITE") agrees to make its best effort to locate a suitable NCP upon request by the below signed client ("Client").

Fees:

Client understands that a $50 membership fee will be charged by ELITE to begin the search process for the NCP. This membership applies to any ELITE temporary service.

ELITE Fees:

$15 agency fee charged for each Newborn Overnight Visit.

Overnight Newborn Nanny Wages:

Overnight Newborn Nannies are paid $12 per hour for one baby, $13 per hour for twins and $14 per hour for triplets with a seven-hour minimum directly by Client at the end of each visit. Client agrees to provide the nanny with a guest room and monitor.

Client agrees to pay ELITE a per visit agency fee via PayPal, check or money order before each visit based on current rates as listed above.

Client agrees to pay NCP directly for services rendered at the end of each visit.

Client understands that the services provided by all ELITE NCPs must be contracted through the ELITE office. Client further understands that the use of an ELITE NCP or the referral of an ELITE NCP to a third party, without arranging the visit through ELITE, is considered "theft of services" and will result in a charge of $1,500 in liquidated damages.

In the event that Client wishes to hire a NCP on a permanent basis, ELITE agrees to negotiate with Client in arriving at an acceptable placement fee. ELITE's standard placement fee for a nanny is $475 for a part-time (under 35 hours per week) and a $850 for full-time (35 or more hours per week).

Client understands that ELITE NCPs are not employees of ELITE. Client understands that Client may be responsible for withholding and filing employment taxes for each calendar year in which the NCP payment exceed the limits set forth in the Internal Revenue Code. Social Security numbers of caregivers must be obtained directly from NCPs.

Cancellation Policy

A. Client understands that a non-refundable agency per diem fee of $15 must be paid in advance upon ELITE's confirming Client's reservation for a NCP.

B. If Client cancels a confirmed session within 24 hours of the scheduled visit, Client will be charged for four hours of the NCP's time in addition to the agency reservation fee.

All deposits are non-refundable.

Liability

Client agrees to indemnify, release and hold harmless ELITE, its agents, employees and officers for any and all claims, damages, and expenses, relating to or arising out of the services provided by NCP.

Client understands that neither NCP nor ELITE is in any way responsible for determining the health and well being of the infant or the mother. The NCP is engaged strictly to provide newborn care. Neither the NCP nor ELITE is responsible for any health or medical assistance regarding the infant, the mother or any family member.

This agreement contains the entire understanding between the parties and shall be interpreted and construed in accordance with the laws of the State of South Carolina.

I have read,understand and agree to the terms of the agreement.

 Agree Disagree

Client's Name (required):

Client's Name (required):

Today's Date (required):

Mother's Name (required)

Occupation:

Place of Employment:

Work Hours:

Work Phone:

Cell Phone:

Email (required):

Father's Name (required)

Occupation:

Place of Employment:

Work Hours:

Work Phone:

Cell Phone:

Email (required):

Home Address (required): Please include STREET, CITY, STATE and ZIP:

Home Phone (required):

Emergency phone contact other then parents (required):

Where do you wish to be reached (home, work, mother's cell, father's cell)?

Please describe your children:

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender ---MaleFemale

School Arrangements/Hours

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender ---MaleFemale

School Arrangements/Hours

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender ---MaleFemale

School Arrangements/Hours

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender ---MaleFemale

School Arrangements/Hours

Please note any special needs (allergies, special instructions, transportation of children, etc.).

Other members of household (relatives, domestic help, older siblings, etc.):

Name: Age: ---123456789101112131415161718192021222324252627282930's40's50's60's70's80's90's Relationship to child

Name: Age: ---123456789101112131415161718192021222324252627282930's40's50's60's70's80's90's Relationship to child

Does anyone in your home smoke?  yes no

Please list any pets:

Do you have a swimming pool?  yes no

Please list previous child care situations, providers, environments (day care, nannies, relatives):

NANNY POSITION INFORMATION:

Type of Nanny your looking for: ---Full-timePart-timeFull-time Live-inSummerFull-time Mommy NannyPart-time Mommy Nanny

Nanny Start date: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---200920102011201220132014201520162017201820192020

Days/Times Nanny Needed:

Day: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday Time: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm To: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm

Day: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday Time: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm To: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm

Day: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday Time: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm To: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm

Day: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday Time: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm To: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm

Day: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday Time: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm To: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm

Salary range (Gross):

Benefits:

Paid Vacation:  yes no
Number of weeks ---1234 after ---123456789101112 months.

Number of paid sick days: ---01234567891011121314

Holidays with pay:

Would you be willing to contribute towards health insurance?  yes no
Amount per month:

Will any weekends be requested?  yes no

Frequency:

Will any overnights be needed?  yes no

Frequency:

Rate of pay:

Describe any travel plans contemplated during the Nanny's stay:
Will nanny be needed?  yes no

Please describe anticipated transportation needs:

Will a car be provided?  yes no
If no, will a car allowance be provided for transportation of children?  yes no

Caregiver Characteristics: Please list important qualities you feel the Nanny should possess.

Caregiver Responsibilities: Please list caregivers duties regarding your child(ren).

Housekeeping Duties: Please list the housekeeping duties you will require of your nanny.

Family Information: Please list any information about your family that may help us in making a successful placement.

Please describe what you feel to be the ideal working relationship between your family and your nanny.

How did you hear about Elite Nannies and Sitters?

Have you used a nanny in the past?  yes no

Are you currently working with any other agencies to find a nanny?  yes no

If yes, please list

I understand that the full placement fee must be paid via PayPal, check or money order before an Elite Nannies and Sitters Nanny begins her employment. I have filled out the application as accurately as possible, including reasonably accurate hours, duties and pay ranges and understand that the credit and replacement policy will be null and void if the position is not consistent with the above job description. I also agree to submit a contract signed by the Nanny and myself prior to the Elite Nanny’s first day of employment.
 agree disagree

Today's Date (required):

Mother's Name (required)

Work Phone:

Cell Phone (required):

Email (required):

Father's Name (required)

Work Phone:

Cell Phone (required):

Email (required):

Home Address (required): Please include STREET, CITY, STATE and ZIP:

Home Phone (required):

Emergency phone contact other then parents (required):

Name of Hotel (required):

Hotel location (required):

Hotel phone (required):

Hotel room number has been reserved under (required):

Arrival date (required):

Room number (if available):

I am interested in using Elite Nannies and Sitters for:

Day: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Date: ---12345678910111213141516171819202122232425262728293031 Year: ---200920102011201220132014201520162017201820192020 Time: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm To: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm

Day: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Date: ---12345678910111213141516171819202122232425262728293031 Year: ---200920102011201220132014201520162017201820192020 Time: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm To: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm

Day: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Date: ---12345678910111213141516171819202122232425262728293031 Year: ---200920102011201220132014201520162017201820192020 Time: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm To: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm

Day: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Date: ---12345678910111213141516171819202122232425262728293031 Year: ---200920102011201220132014201520162017201820192020 Time: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm To: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm

Day: ---SundayMondayTuesdayWednesdayThursdayFridaySaturday Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Date: ---12345678910111213141516171819202122232425262728293031 Year: ---200920102011201220132014201520162017201820192020 Time: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm To: ---12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pm

Please describe your children:

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: 12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender ---MaleFemale

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender ---MaleFemale

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender ---MaleFemale

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender ---MaleFemale

Please add anything that you feel is important for us to know concerning your children and your plans (Allergies, Special Instructions, etc.).

How did you hear about Elite Nannies and Sitters?

Elite Nannies and Sitters Temporary Services Client Understanding and Release:

Understanding between parties:
1. Elite Nannies and Sitters agrees to make its best effort to locate temporary child caregivers for clients’ child care needs on an as requested basis.
2. Client agrees to pay Caregiver directly for services rendered at least $12.00 per hour for 1child plus an additional $2 per hour for each additional child (up to 5 kids) for a minimum of 4 hours plus any parking charges.
3. Client understands that the agency fee must be paid in advance via PayPal, check or money order for every caregiver visit. Agency fee: $30 initial agency set up fee and $15 for each additional sitter visit.
4. Client understands that the services provided by all caregivers associated with Elite Nannies and Sitters must be contracted through the Elite Nannies and Sitters office. Client agrees that he/she will not hire or refer an Elite Nannies and Sitters caregiver to a third party without the consent of the Elite Nannies and Sitters office. Client further understands that use of an Elite Nannies and Sitters caregiver without arranging the visit through Elite Nannies and Sitters will result in a charge of $1000 for liquidated damages. Client further understands that Elite Nannies and Sitters will negotiate a reduced placement fee if client wishes to hire a caregiver on a regular basis.
5. Client understands that all caregivers working with Elite Nannies and Sitters are not employees of Elite Nannies and Sitters. Client understands that if they pay more than $1,700 per calendar year to any one caregiver they are responsible for withholding and filing employment taxes for that person.
6. Client agrees to forever indemnify, release and hold harmless Elite Nannies and Sitters, its agents, employees and officers for any and all claims relating to services provided by Caregivers.
7. Client understands that the hotel swimming pool is completely off limits with an Elite Nannies and Sitters Caregiver. Caregiver may not take client’s children swimming in the hotel pool.
8. Client understands that a caregiver may not take children off of the hotel premises.

I have read and understand the terms of the agreement.
 Agree Disagree

Medication Release: (optional)

I hereby give my consent for an Elite Nannies and Sitters caregiver caring for children in my home, to administer medication to my child(ren). I understand that Elite Nannies and Sitters caregivers are not medically trained. I hereby release, discharge and hold harmless Elite Nannies and Sitters, its employees, agents, and officers from any and all claims relating to the administering of medication to my child(ren).

I understand and agree to the above medical release waiver.
 Agree Disagree

Thank you for using Elite Nannies and Sitters!

Today's Date (required):

Mother's Name (required)

Occupation:

Place of Employment:

Work Phone:

Cell Phone:

Email (required):

Father's Name (required)

Occupation:

Place of Employment:

Work Phone:

Cell Phone:

Email (required):

Home Address (required): Please include STREET, CITY, STATE and ZIP:

Home Phone (required):

Emergency phone contact other then parents (required):

I am interested in using Elite Nannies and sitters for (click all that apply):
sick care ---YesNo evening sitting ---YesNo back up care ---YesNo 24 hour care ---YesNo overnight care ---YesNo 1-6 week placement ---YesNo2-6 month placement ---YesNo

Please describe your children:

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender ---MaleFemale

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender ---MaleFemale

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender ---MaleFemale

Name: Month: ---Jan.Feb.MarchAprilMayJuneJulyAugustSept.Oct.Nov.Dec. Day: ---12345678910111213141516171819202122232425262728293031 Year: ---20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Gender ---MaleFemale

Will you be present when the caregivers are with your children?  yes no

Please list any pets:

Do any other family members or friends live in your home (e.g. grandparents)?  yes no

Will they be there when the caregiver is present?  yes no

Please describe situation:

Does anyone in your home smoke?  yes no

Please add anything that you feel is important for us to know concerning you and your family (allergies, special instructions, etc.).

Please update Elite Nannies and Sitters regularly with new children, addresses, phone numbers, and pets.

How did you hear about Elite Nannies and Sitters?

Would you like more information regarding other Elite Nannies and Sitters services (click all that apply)?

Nanny Placement Service: ---YesNo Party Helpers: ---YesNo House and Pet Sitters: ---YesNo Group Care: ---YesNo

Elite Nannies and Sitters Temporary Services Client Understanding and Release:

Understanding between parties:

1. Elite Nannies and Sitters agrees to make its best effort to locate temporary child caregivers for client’s child care needs on an as requested basis.
2. Client agrees to pay caregivers directly for services rendered at least $10.00 per hour for 1-3 children and $12.00 per hour for 4-5 children. For “sick child care”, client agrees to pay caregivers at least $11.00 per hour for 1-3 children and $13 per hour for 4-5 children. Client agrees to pay “Party Helpers” $15 per hour. There is a four-hour minimum on all jobs.
3. If applicable, client agrees to pay pet sitter directly for services rendered at least $25 for 1-2 visits per day and $40 for 3 visits per day or overnight. Client agrees to pay house sitter $20 for 1 visit per day and $25 per overnight visit.
4. Client understands that a non-refundable Agency fee must be paid in advance via PayPal, check or money order for every confirmed reservation.
5. Client understands that if s/he cancels a caregiver who has already been confirmed by Elite Nannies and Sitters s/he will be charged the agency reservation fee. Client further understands that if cancelling with less than 24-hour notice, s/he will be charged the four-hour minimum for the caregiver in addition to the agency reservation fee.
6. Client understands that the services provided by all caregivers referred by Elite Nannies and Sitters must be contracted through the Elite Nannies and Sitters office. Client further understands that the use of an Elite Nannies and Sitters caregiver, or referral of an Elite Nannies and Sitters caregiver to a third party, without arranging the visit through Elite Nannies and Sitters, is considered “theft of services” and will result in a charge of $1000 for liquidated damages.
7. In the event that Client wishes to hire a Caregiver referred by Elite Nannies and Sitters on a permanent basis, Elite Nannies and Sitters agrees to negotiate with the client in arriving at an acceptable placement fee. Elite Nannies and Sitters standard placement fee for a permanent Caregiver (“Nanny”) is $475 for a part-time Nanny, (under 35 hours per week), and $850 for a full-time Nanny (35 or more hours per week).
8. Client understands that caregivers working with Elite Nannies and Sitters are not employees of Elite Nannies and Sitters. Client understands that if they pay more than the allotted government amount per calendar year to any one caregiver s/he is responsible for withholding and filing employment taxes for that person. Social Security number of caregivers must be obtained directly from caregivers.
9. Client agrees to forever indemnify, release and hold harmless Elite Nannies and Sitters, its agents, employees, and officers for any and all claims relating to services provided by caregivers.

I have read and understand the terms of the agreement.

 Yes No

Transportation Waiver: (optional)

I hereby give consent for an Elite Nannies and Sitters caregiver to transport my child(ren) in her or my automobile. I understand that caregivers with Elite Nannies and Sitters are not employees of Elite Nannies and Sitters. Elite Nannies and Sitters is in no way responsible for the safety of my child(ren) while being transported in caregivers or our family’s automobile. I agree to forever indemnify, release and hold harmless Elite Nannies and Sitters, its agents, employees and officers for any and all claims including injury to client’s car of child(ren) while being transported by an Elite Nannies and Sitters caregiver.

I understand and agree to the above transportation waiver.
 Agree Disagree

Medication Release: (optional)

I hereby give my consent for an Elite Nannies and Sitters caregiver caring for children in my home, to administer medication to my child(ren). I understand that Elite Nannies and Sitters caregivers are not medically trained. I hereby release, discharge and hold harmless Elite Nannies and Sitters, its employees, agents, and officers from any and all claims relating to the administering of medication to my child(ren).

I understand and agree to the above medical release waiver.
 Agree Disagree

Thank you for using Elite Nannies and Sitters!