Reliable Nanny Connection Intake Form

Name*

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Age*

Current job*

Current student?*

Marital status*

Children?*

If yes, how many and what ages?

Educational background*

Please specify high school diploma or GED, and any college degrees.

What's your favorite part about being a childcare provider and what skills and knowledge do you have to bring to families homes?

Do you consent to a background check?

Please upload a photo of your driver's license or state issued ID to conduct your background check

Contact E-mail*

example@example.com

Mother language and additional languages*

Please let us know your first language and if you speak other languages fluently.

Do you smoke, consume marijuana, or vape?*

Do you suffer from any allergies?*

Food, pets, nature, etc.

Do you have any medical conditions that can affect your ability to handle the demands of a childcare position?*

If yes, please provide detail.

What are your hobbies and pastimes?*

Have you received the COVID-19 vaccine?*

If yes, please let us know the date of your last vaccine. *

If you have not been vaccinated, please write "n/a"

Have you receive tuberculosis testing clearance?*

Please list your vaccine history *

Please include dates for any of the following you have received: tetanus-diptheria-pertussis/whooping cough, flu, MMR, chicken pox/varicella, Hepatitis A, Hepatitis B, Meningococcal. If no vaccines, please write "none".

Do you have a valid driver's license?*

Do you have a reliable form of transportation for commuting to work? *

Can include car, public transport, etc.

If you have a car, do you have insurance?*

Are you looking for a position that allows you to bring your child to work? *

Have you worked as a nanny with your own child in a previous role?*

What type of childcare job are you looking for?*

Part-time, full-time, short-term, long-term, occasional

How far from home would you be prepared to travel to work?*

Please give an approximate measure in hours or miles.

Would you be willing to travel with us?*

Availability*

Would you be willing to work occasional weekends?*

Are you willing to be on call? Please list your availability for our on call shift(s) 6am-2pm, 2pm-11pm, 11pm-6am) reliable transportation required. Please list if you would need to bring your child(ren) and their ages. Please specify your availability Monday through Sunday.

What hours would you like to ideally work?*

Are your hours flexible?*

What is your ideal childcare job?*

Please include any relevant details including number of children, live-in/live-out situation, age of children, daily activities, etc.

Would you be willing to work occasional date nights?*

What are the ways that you mitigate calling out of work? Attendance is extremely important in maintaining a position with us.

Do you agree to follow our attendance policy and give 24 hours notice to call out?

How many years of experience do you have working with children?*

What are your formal childcare qualifications?*

Please include any of the following: CPR, First Aid, water safety training, certificates, classes, degrees, etc.

Experience*

Additional skills

If you selected "other" please share your additional skills.

Gross salary expectation (hourly)*

Please list a range of two numbers (x-x) or a set number (x) in USD$

Payment method preference (check, cash, Venmo, etc.)*

Payment frequency preference (weekly, biweekly, monthly, etc.)*

Earliest start date*

DD/MM/YY

Please tell us about your last childcare position*

Please briefly describe your duties, number of children, ages of children, and live-in/live-out situation.

Did you perform any of the following duties in your role: housework, pet care, and meal preparation?*

If yes to any, please describe in brief detail. If no, please write "n/a".

Employer's contact number

Employer's email address

example@example.com

Can we contact this employer for a reference?*

Employer 2 (childcare preferred but not required)*

Job title*

Duties*

Start / end date*

Reasons employment ended

Additional information about this position

Employer's contact number

Employer's email address

example@example.com

Can we contact this employer for a reference?*

Employer 3 (optional)

Job title

Duties

Start / end date of employment

Reasons employment ended

Employer's Address

Employer's contact number

Employer's email address

example@example.com

Additional information

Please use this space for anything else you would like us to know.

To ensure clarity and ease of understanding, we've outlined a policy for all nannies associated with Reliable Nanny Connection LLC:

Expectations for Exceptional Nannies:
- Punctuality: Arrive on time for work.
- Enthusiasm: Display a positive attitude and genuine interest in your work.
- Communication: Ask relevant and engaging questions.
- Preparedness: Come with a well-thought-out plan of activities.
- Technology Usage: Limit phone and screen time according to each family's preference.
- Documentation: Take thorough notes on the care provided for the family's reference.

Additional Agreements:
1. All scheduling matters must be communicated through the agency for clients associated with Reliable Nanny Connection LLC.
2. Nannies must attend ongoing training sessions to enhance their skills.
3. Adhere to a strict attendance policy, providing 24-hour notice for any absences, barring sudden illness. A doctor's note is required for absences with less than 24-hour notice.
4. Maintain detailed care notes for the families under your care, prioritizing the safety of your clients.

Payment Arrangements:
- Nannies will be compensated directly by the family.
- Electronic payments are acceptable until reaching $2200 in earnings. Beyond this threshold, transitioning to payroll payments is necessary to comply with IRS guidelines for household employees.

Reliable Nanny Connection nannies agree not to book hours with Reliable Nanny Connection clients or referrals from RNC clients without contacting the agency to book directly. Doing so will result in litigation.

By signing this document, you acknowledge and agree to abide by the outlined policies and expectations as a nanny affiliated with Reliable Nanny Connection LLC.

Please attach a clear and professional looking photo free of any offensive logos. Bright lighting, smiling, straight on.

Clear and professional photo

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Signature

Reliable Nanny Connection Intake Form

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