Start Date (required):

Worksite Address (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 Phone (required):

Emergency phone contact other than parents (required):

Work Schedule:
The following represents a typical schedule. Employer will limit fluctuations as much as possible and provide as much notice as possible.

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Children being cared for

Name:
Month:
Day:
Year:
Gender
Name:
Month:
Day:
Year:
Gender
Name:
Month:
Day:
Year:
Gender
Name:
Month:
Day:
Year:
Gender

Regular Rate of Pay

Overtime Rate of Pay
(More than 40 hours in one week.)

Wages will be paid:

Fair Labor Standards Act Notice: With very few exceptions, domestic employees are classified as “non-exempt” (protected workers, which entitles them to pay for every hour they work at a rate that may not be less than federal, state, and if applicable, local minimum wage rate. Additionally, overtime (time-and-a-half) must be paid for each hour over 40 in a 7-day workweek. There are few exceptions and special requirements based on type of worker and state of residence.

Mileage & General expenses:
Any miles driven while on the job using the employee’s vehicle will be reimbursed at the IRS Mileage Reimbursement Rate, which cover the cost of gasoline as well as general wear and tear on the vehicle. Employee will maintain a mileage log and submit to employer for reimbursement at the end of the pay period. The current IRS mileage reimbursement rate is 54 cents per mile.

Tax-advantaged Benefits:
In addition to the wages stated above, employer will contribute to the following employee expenses. These amounts are considered “non-taxable” compensation (up to the limits noted below), Meaning neither employer nor employee will pay an taxes onto his portion of the compensation (check any that apply)

Health Insurance at $

Public Transport at at $

Parking at $

College Tuition at $

Mobile Phone service at $

Paid time off:
Employee will receive the following paid time off:

Sick leave . Week(s) notice is requested or any appointments etc. which may cause the employee to miss work.

Vacation . Employee will provide vacation request at least weeks in advance.

*PARENTS ARE NOT REQUIRED BY FEDERAL LAW TO PROVIDE PAID TIME OFF.

Holidays:

Employer will provide the following PAID holidays (check any that apply)

New YearMartin Luther King, Jr.’s BirthdayPresident’s DayMemorial DayJuly 4thLabor DayThanksgiving DayChristmas

*Any Holidays worked by your caregiver should be at the rate of $3 more per hour.
*PARENTS ARE NOT REQUIRED BY LAW TO PROVIDE PAID HOLIDAYS.

Tax Withholding’s / Reporting

Employer will withhold the required Social Security & Medicare taxes from the employee’s pay, along with income taxes per the employee’s instruction on Form W-4 and all other applicable state taxes.

All tax withholdings will be remitted to the state and federal tax agencies on or before the household employment tax deadlines. In addition, employer will match the employee’ Social Security & Medicare contributions to the state and federal unemployment insurance funds on behalf of the employee.

Employer will provide employee with form W-2 at the end of the year (by January 31)

Employer will report employee’s earnings to the Social Security Administration so that employee receives appropriate retirement benefits.

Confidentiality:

Employee understands that any and all private information obtained about the employers or their dependents during the course of employment, including but not limited to medical, financial, legal and career, are strictly confidential and may not be disclosed to any third party for any reason.

Grounds for Termination:

The following are grounds for immediate termination:

  • Allowing the safety of the dependent(s) to be compromised
  • Inconsistent or non-performance of agree- upon job responsibilities.
  • Dishonesty
  • Stealing
  • Misuse of family automobile
  • Breach of confidentiality clause
  • Persistent absenteeism or tardiness
  • Unapproved guest
  • Smoking or consumption of alcohol while on duty
  • Use of illegal drug(s)

I have read and understand the terms of the agreement