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Date |
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Last Name |
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First Name |
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Phone |
home
cellular |
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Fax Number |
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Email Address |
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Marital
Status |
Single
Married
Divorced |
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Spouse's Name
(if applicable) |
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Family's Address |
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City |
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State |
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Zip Code |
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EMPLOYMENT INFORMATION |
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Employer |
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Work Phone |
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Work Address |
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Work City |
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State |
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Zip Code |
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Spouse's Employer |
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Spouse's
Work Phone |
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Spouse's Work Address |
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City |
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State |
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Zip Code |
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SERVICES REQUESTED |
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Type of care requested. Check
all that apply. |
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Desired Start Date |
Note: We cannot guarantee a
placement by the start date; but we will do our very best. Placements of
caregivers generally take between (2) to (8) weeks. |
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Earliest Date of Arrival |
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Latest Date of Arrival
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| Shortest
Period of Stay |
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| Longest
Period of Stay |
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Caregiver's Work Schedule |
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Are these hours flexible? |
Explain
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How often does your work require travel? |
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How long of a commitment do you want from your
nanny? |
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INSTRUCTIONS FOR CHILD & HOUSEHOLD CARE |
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Which best describes your nannyâs daily
responsibilities and priorities. |
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Do you currently have housekeeping service? |
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What will your nanny be responsible for? |
*Click on links for exact definitions.
Light
housekeeping Housekeeping
Light
cooking
Cooking
Children's
laundry
Family's
laundry
Errands
Travel with
family
Care
for pets
Other
Note: If you are hiring a nanny who is responsibilities include both
housekeeping and childcare, please acknowledge that housekeeping limits
the nannyâs quality time and interaction with pre-school age child(ren).
Some nannies do not house clean; and if they do, their charge is extra and
negotiable. If you would like quality childcare, it is best to hire a
housekeeper who will be responsible for housekeeping only, and a nanny
responsible for childcare only. |
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Do you have any pets?
If "yes" describe your pets?
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Do you expect your nanny to care for pets? |
Note: Most caregivers describe in their application if they are
allergic to pets or pet hair; however, some are willing to still work
for a family with pets under certain conditions (such as keeping the
common areas of the home thoroughly vacuumed). This situation can be
explained during their interview, or with you CRI's referral and
placement consultant. |
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COMPENSATION & BENEFITS
PACKAGE |
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Pay range |
Note: Please keep in
mind that nannies generally charge a range of $10 to $12 per hour & up
(before or after taxes), depending on your job description. The nanny's
salary and hourly rate is negotiated between you and the caregiver during
you interview. Most nannies "talk in terms of take home pay", please
negotiate the tax issue with your hired caregiver during your interview.
Please refer to the information in your application package by our
preferred domestic accounting tax service. |
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Proposed NET weekly salary |
$ |
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Hourly part-time rate |
$ |
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Hourly over-time rate |
$ |
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Flat rate for overnight stays |
$
Note: Generally $50.00 - $125.00 for 12 hour overnight stays, plus hourly
rate for AM to PM care. |
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Additional benefits that apply |
Note: Most holidays include: New Year's
Day; MLK Jr. Day; Good Friday; Memorial Day; Independence Day; Labor Day;
Thanksgiving Day; Hanukkah; and Christmas
Paid
Holidays how many
Paid
sick days after how many
months of employment
Paid
vacation days after how many
months of employment
Holiday
bonus pay $
payable on
Guaranteed
pay or paid vacation days when the family vacations over on or two weeks.
Guaranteed
pay (nanny's salary will not change if the negotiated flexible hours
decrease).
Annual
and "good performance" raise $ or %
included in next
years weekly salary.
Health
Insurance Explain:
Auto
Insurance
Mileage
reimbursed for pick-ups and drop-offs at school and errands per mile
(.25¢ - .32¢/mile).
Reimbursement
of recertification of CPR and First Aid courses (generally $30-$45).
Paid
membership in the American Nanny and Childcare Training Institute, a
not-for profit
organization that provides Au Pairs and Nannies with
continuing education, invitation to workshop
training, coordination of playgroups and socialization for
nannies and children.
Annual membership fee
is $35.00, and can be included in your balance or charged to your account
annually at your request. |
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TRANSPORTATION |
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If your nanny purchases additional
medical/insurance coverage on her automobile to transport your child(ren),
are you willing to reimburse this expense? |
Yes
No |
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Is there access to public transportation
(MARTA) near your neighborhood? |
Yes
No |
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Would you accept a nanny who does not
drive, but has dependable transportation?
(such as a spouse taking them to work on their
way to work; etc.) |
Yes
No |
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Would your nanny (who drives) have use of
the family's car while on the job to run errands? |
Yes
No,
we do not have a second or third vehicle for the nanny
We
prefer for the nanny to use her own vehicle. |
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ACCOMMODATIONS |
If you are hiring a live-in nanny or an
Au Pair, please check the following provided accommodations. |
Living
arrangements:
Private bedroom
Private bathroom
Shared bathroom
with the child(ren)
Furnished
Partially
furnished
Are the living quarters located:
In the basement
Private
second entrance
Over the garage
Separate
apartment
Other
Other amenities:
Use of private
telephone line TV
Linens
Food
Internet Service
Other
Nanny
has permission to stay at your family's home (if desired) during the
weekend, or when off
duty?
Note: Please include detailed
policies in your employment agreement concerning the use of these
amenities, such as the use of family's telephone for local and
long-distance calls; policies for visitors; use of amenities of the
accommodations; and waiver of any liabilities; etc. |
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Will your live-in nanny have use of the
family's car while off the job.
If applicable |
Yes
No |
Please describe your home.
(Nannies sometimes want a
description of where they will live or work.) |
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Describe the atmosphere in your home. |
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Which
Languages other than English are spoken in your home?
(Hold down the CTRL key for multiple selections)
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| Religion |
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Do you attend services regularly? |
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Does anyone in your household
smoke? |
Note: This is a smoke-free nanny agency, and we seek non-smoking
caregivers. From past experience, we know that most parents are not
interested in caregivers that smoke; however, we can not always
guarantee that all registered caregivers do not and will not smoke. |
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ADDITIONAL CHILDCARE
OPTIONS -
If you are interested, the following may provide you with additional
childcare options at a reduced rate. |
Share-a-Nanny
One nanny shared between two
families can provide equal childcare with a salary that both families can
afford. You must locate the other family in your area, and be the signee
and spokesperson to coordinate the nanny referrals, interviews, and
placement. The placement fee is shared between the two families. |
Sign
me up.
No
thanks.
|
Share Care
A qualified and experienced
nanny who would bring their own child (mostly an infant or toddler) to
your home to care for your child(ren) and theirs thus reduces the cost of
their weekly salary. This type of care provides socialization and a
learning experience for preschool children. The nanny understands her role
in providing quality and personalized care for each child - not just her
own. |
Sign
me up.
No
thanks.
|
Describe the best nanny for your family.
Please inform us if you have an ethnicity preference, or if a nanny "must
have" certain requirements. In our search, we cant' always guarantee
that we will be able to exactly match your detailed request within a
specific time frame. We will, however, try our best in our search
and referral process. |
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INSTRUCTIONS FOR CHILDCARE |
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Children |
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Do any of your children have special needs?
If "yes" please describe. |
If "yes" please explain |
Extracurricular Activities
Note: If the nanny will be
responsible for taking or picking up your child(ren) from these
activities, and/or providing special needs, please provide specific
instructions during your orientation and in the employment agreement. |
If "yes" please explain |
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NANNY INTERVIEWING
INSTRUCTIONS |
Please provide directions to your home or
office from the nearest highway.
(I-285, I-85, I-75, I-20, or GA-400) |
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Best time to interview
Note: We will coordinate the
caregivers interview at a convenient time. |
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ADDITIONAL SERVICES |
NEW coming
ASAP...Nannies on the Webú
You can have exclusive access to
download digital videos and read detailed profiles on of referred
caregivers. This service saves "record breaking time" in research and
selecting a caregiver, and we are proud to be the 1st to offer it! |
Order.
No
thanks. |
Nannies on DVDú
Provides you with a preview of
the referred candidates on DVD, at a cost of $150.00 plus shipping and
handling. |
Order.
No
thanks. |
Employment Agreement Package
This employment agreement
package includes copies of sample employment agreements, and a convenient
"fill-in-the-blank" employment agreement, in addition to various forms
that include medication forms, emergency contact forms. The cost of this
package is $15.00
Note: This service is very important, however; you are very welcomed to
write your own employment agreement contract with your hired caregiver.
Please be aware that the employment agreement is a detailed job
description that is to be negotiated between you AND your hired caregiver,
with a copy provided to your nanny, and then returned to Childcare
Resources, Inc. via fax or certified mail within FIVE (5) business or your
six month research referral guarantee will be unfortunately forfeited. |
Order.
No
thanks, we will use our own placement agreement and submit it as required. |
|
How did you hear about Childcare Resources,
Inc.? |
Yellow/White
Pages
News
Media
Internet
Magazine:
Other:
Personal
Referral from:
They
are current clients on file.
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|
Thank you for your trust
and confidence in our service. We appreciate your patronage. |
