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Date:________Name:_______________________________________________________________________Name(Spouse):_______________________________________________________________Home Address:_______________________________________________________________City:_______________________________State:_______________Zip:__________________Home Telephone:_________________________Cell Phone:__________________________Email Address:_________________________________Your Profession:______________________________________________________________Business Address:____________________________________________________________City:_______________________________State:_______________Zip:__________________Business Telephone:____________________________Spouse’s Profession:__________________________________________________________Business Address:____________________________________________________________City:_______________________________State:_______________Zip:__________________Business Telephone:____________________________What is your preferred mode of contact? Home Telephone___ Cell Phone___ Other(Specify)_________________________Child’s Name_______________________________________Age:_________________Child’s Name_______________________________________Age:_________________Child’s Name_______________________________________Age:_________________Pets:_________Type:____________Breed:__________Indoor/Outdoor?Does your family maintain other residencies?__________If so, please describe:_____________________________________________________________________________________________________________________________________What other household staff do employ? (Housekeeper, Cleaning Services, etc..)________________________________________________________________________________________________________________________________________________________Type of community:Urban___ Suburban___Rural___Nearest major city:__________________What date would employment commence?____/____/____Private accommodations available within the residence?____ Bed___Bath__Kitchen__Will there be an automobile available? Yes___ No___Please describe your personality:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please describe your spouse’s personality:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What are your family’s lifestyles and interests?:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What type of personality do you seek in a nanny?:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please list any special skills or abilities you desire the nanny to have?:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please list any special circumstances with the children of which the nanny should be aware of:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Where did you learn of Little Sheep Nanny Agency?:___________________________________________________________________________________________________________The following fees are applicable for Little Sheep Nanny Agency:Application Fee = $100.00 (Due with application)Placement Fee = $1050.00 Full time $725.00 Part time $525.00 TemporaryThe placement fee is due upon arrival of specified nanny.The application fee will be deducted off of final fee due.By signing this, I hereby certify that the above answers are true, and that we agree to the terms set forth in the enclosed Employer Agreement. I agree to release and promes to hold the Little Sheep Nanny Agency harmless for any act of the nanny. I also agree to hold Little Sheep Nanny Agency harmless of any claim as a result of the placement.Signature:____________________________________________Date:___________________Employer understands and acknowledges that Little Sheep Nanny Agency is not an agent or representative of the nanny, and the Little Sheep Nanny Agency is not in any way liable for any loss, damage, expense, or injury which the employer or any other person may suffer or incur as a result of the wrongful acts, omissions, or negligence of the nanny.Little Sheep Nanny Agency assumes no responsibility for paying or withholding any federal or local taxes, social security contributions, or insurance premiums required or arising from the nanny’s employment with the employer.Little Sheep Nanny Agency is a referral service and shall not be liable for any damages caused by any nanny referred to you. Little Sheep Nanny Agency assumes no liability or responsibility to confirm and verify all information and references supplied to the employer to ensure such placement. The employer agrees that Little Sheep Nanny Agency is not responsible for events beyond their control. Little Sheep Nanny Agency is not liable for the acts and/or omissions of the nanny. Little Sheep Nanny Agency is not liable for any claims of whatever nature the nanny may have against the employer. The employer hereby agrees to indemnify and hold Little Sheep Nanny Agency harmless for any and all such claims.Little Sheep Nanny Agency warranties your nanny for 90 days from the date of arrival in your home. If within that time, you find a nanny to be unsatisfactory, or, if the nanny should resign, Little Sheep Nanny Agency will attempt to provide a qualified replacement. If we are unable to provide you with a suitable replacement, or the employer does not wish to continue working with the Little Sheep Nanny Agency, percentage of the total fee paid as per the following schedule:Days of Employment % of Total Fee Refunded0-29 … 30%30-60 … 20%61-90 … 10%After 90 … 0%Employer shall refrain from making any private agreement with the nanny, or for taking any action, which is inconsistent with this agreement, or which has the effect of avoiding any of the employers obligations herein. Such private agreements, and actions, include, but are not limited to actions which would enable the employer, or any other person to avoid payment of the registration, and or placement fees due to Little Sheep Nanny Agency. For example, if the employment refers the name of the nanny to another person who subsequently employs the nanny. You are liable to Little Sheep Nanny Agency damages in the event you refer any Little Sheep Nanny Agency referral to a third party.Any claim or controversy arising out of, or relating to this agreement or the breach thereof, shall be settled by arbitration in the state of Connecticut in accordance with the rules of the American Arbitration Association, and judgement upon the award of the arbitrators may be entered in any court having jurisdiction thereof.I have read and understand this contract, and I agree with all of the terms and conditions, and I confirm by signing below.Employer:__________________________________Date:_______________________Employer’s Address: ____________________________________________________Employer’s Phone Number:_______________________________________________Little Sheep Nanny Agency:___________________Date:_______________________ ................
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