The Nannies Agency Application

Full Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

Birth Date*

MonthDayYear

Social Security Number

Are you a U.S. citizen?*

YesNo

Do you own a car?*

YesNo

Do you have a drivers license?*

YesNo

Driver's license number*

Expiration date*

Driver's license issuing state*

Are you looking for a live in or live out position?*

Years experience*

Date you can start*

MonthDayYear

Salary desired*

Are you registered with Trustline?*

YesNo

Are you CPR/First Aid certified?

YesNoWilling to get certified

Previous job experience. Please check all that apply*

I have my GED*

YesNo

High School*

Name of High School Attended

Number of years attended*

Graduated?*

YesNo

College

Name of College/University Attended

Number of years attended

Graduated?*

YesNoSome College

Area of Study/Degree

Trade School/Other

Name of Trade/Technical/Other School Attended

Number of years attended

Graduated?

Yes

Area of Study/Degree

Skills*

List any relevant skills

What languages do you speak?*

Qualifications*

List any relevant certifications or qualifications

Current Employer*

Name of Current Employer or NONE if not Employed

Position*

Salary

Start Date

MonthDayYear

May we contact?

YesNo

Previous Employer*

Name of Previous Employer

Position*

Salary

Reason for leaving?

Start Date

MonthDayYear

End Date

MonthDayYear

Previous Employer

Name of Previous Employer

Position

Salary

Reason for leaving?

Start Date

MonthDayYear

End Date

MonthDayYear

Reference 1*

Name of Reference

Relationship*

Years acquainted*

Phone*

Email

Reference 2*

Name of Reference

Relationship*

Years acquainted*

Phone*

Email

Letters of Rec

Upload a File

Resume

Upload a File

Do you give us permission to conduct a criminal background check?*

YesNo

Do you give us permission to conduct a DMV report?*

YesNo

Do you give us permission to conduct a credit check?*

YesNo

Are you willing to take a drug test if requested for employment?*

YesNo

These terms (the “Agreement”) set forth the terms and conditions under which individuals residing in the United States may use the Company’s services provided through [Company Website] or any other channels (“Services”).

By clicking the submit button below:

1. I certify that all of the information provided by me in this application (the “Application”) is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed by an affiliate of The Nannies LLC (the “Company”) affiliates, my employment may be terminated at any time.
2. I give the Company permission to conduct background checks that will include but are not limited to DMV report, TrustLine Verification, criminal report, credit report, verification of social security number and verification of references. The Company may disclose any information found in the background checks or any information in my Application to (i) the Company’s clients, employees, affiliates, consultants, independent contractors, agents or advisors. I also give permission to the Company’s clients to conduct their own background checks on me.
3. I acknowledge and agree that the Company is not my employer and that my relationship with the Company should not be construed to be a partnership, joint venture or employer-employee relationship.
4. I understand that the Company may refer me to client(s) of the Company. I agree that I will not, directly or indirectly, except in collaboration with or with the prior express written consent of the Company enter into any transaction with any party/parties introduced to me by the Company which could have the effect of preventing the Company from receiving the full benefit of the Company’s Services. I acknowledge and agree that if I accept or start employment with or am otherwise engaged by any person introduced to me by the Company, I will promptly notify the Company and provide the Company with a written copy of any related agreement or, in the case of an oral agreement, a summary of such agreement.
5. I understand the Company provide me with information, whether in graphic, written, electronic or oral form, identified at the time of disclosure as confidential, or which by its context would reasonably be deemed to be confidential, including without limitation, information of a private, secret or confidential nature concerning the Company’s business, business relationship, or the Company’s clients (collectively, “Confidential Information”). I agree that the Confidential Information is and shall be the exclusive property of the Company. I further agree that I will not disclose any Confidential Information to any person or entity other than employees or advisors of the Company or use the same for any purposes (other than in the performance of my duties with any such client of the Company so long as the Confidential Information solely relates to such client) without the prior written approval of the Company, unless and until such Confidential Information has become public knowledge without my fault.
6. Limitation of Liability. To the maximum extent permitted by applicable law, in no event will the Company be liable to me for any lost profits or lost business or for any consequential, incidental, special or indirect damages of any kind, whether arising in contract, tort or otherwise, and regardless of whether the Company has been notified of the possibility of such damages.
7. Indemnity. I hereby agree to indemnify an hold the Company and its affiliates and its and their directors, officers, employees, and agents harmless from and against any and all liabilities, losses, damages, costs and expenses (including without limitation reasonable attorneys’ fees) related to any third-party claim, suit, action or proceeding arising out of (i) the negligence, willful misconduct or material breach of any obligation, representation or warranty by me under this Agreement and (ii) any services I perform for any party introduced to me by the Company.
8. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.

Signature*

The Nannies Agency Application:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Background Check Authorization