Live In Client Application Form

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First Name: *

Last Name: *

Street Address:

Zip: *

City in Miami-Dade County: *

i.e., Coral Gables or Pinecrest or Aventura

E-mail: *

Cell Phone: *

Home Phone:

Job Description: *

Select all that apply

Live-In

Live-Out

Part-Time

Other:

Required

What position are you looking to fill? *

Select all that apply

Nanny

Housekeeper

Elderly Companion

Baby Specialist (temporary 24 hr or overnight care)

As-Needed Babysitter

Tutor

Homework Helper

Other:

Required

List Days of Work Schedule *

i.e., Monday - Friday

List Hours of Work Schedule *

i.e., 9am-5pm

Child(ren) or Elderly Person:

please provide name, age, and gender

What household duties do you wish the employee to perform?

Check all that apply - be mindful of your needs.

family laundry

fold and put away clothes

iron

family dishes

make all beds

change sheets

clean main living areas

clean windows

clean bathrooms

vacuum

mop

dust

maintain grocery list

grocery shop

take out trash

wipe down counters

run errands

change diapers

cook for parents

cook for kids

bathe child

Other:

What requirements do you require the employee to possess?

Check all that apply - be mindful of your needs.

Speak English

Speak Spanish

Own a Car

drive

drive using the candidate's car

drive using the client's car

swim

wear a uniform

baby-sit in the evenings

travel with family

take care of pet

observe dietary laws

Other:

If dietary laws, which kind?

If pets, what kind?

If pets, please list the employee’s responsibilities with the animal(s)?

If yes, what are your typical travel destinations?

What other qualifications do you require?

Please list any disqualifying factors?

Family/Job Dynamics:

Check all that apply.

Both parents work

Someone in the family smokes

There's a separate bedroom for the live-in employee

There's a separate bathroom for the live-in employee

Employee has health benefits

Employee has paid time off

Employee has paid holidays off

Both parents live in the home

Other:

Which holidays would the employee have off?

What is the salary range PER WEEK for live in? *

General preference of interview days and times: *

Turn by turn directions to your house/interview location: *

If applicable, please include parking instructions (i.e., valet at building)

Location of public transportation:

How did you learn about Class Act Nannies, LLC?

When do you need the candidate to begin employment? *

YYYY

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