Dear Family,
Please complete the following family application. Our Staff will get back with you within one business day.
First Name:
Last Name:
Address:
City: State: Zip:
Major Cross Streets:
Are you in a gated community? Gate Code:
Day Phone: Cell:
Fax: E-mail:
Responsible Persons Full Name:
Responsible Persons Occupation:
Your Occupation:
Do you require special care, medication or therapy of any kind?
If yes, please specify:
Is the Caregiver required to cook?
Are there any special dietary needs?
Do you have pets?
If yes, type of pet and how many?
Will the caregiver be in contact with your pets?
How did you hear about us?
FAMILY AGREEMENT
I have contacted Nannies & Housekeepers, U.S.A. to help me find household help. Under the provisions of the Housekeeping Registry program I understand that all reservations must be made through the agency and is based on availability of housekeepers for the time of service. I will pay the annual membership and booking fees in full and sign the contract before the person begins working in my home.
I will not attempt to hire anyone Nannies & Housekeepers, U.S.A. sends me under the Housekeeping Registry program without processing all of the necessary contracts through their office. I will not refer any of the housekeepers to anyone for potential employment without processing the contract and fee through Nannies & Housekeepers, U.S.A.
I understand the Nannies & Housekeepers, U.S.A. has invested in the interviews and background checks of the candidates and I will allow them to act as the referral agency.
If you agree to the terms listed above type "Yes" in the following space:
