For Nannies:

What would the nanny's duties be? Please keep in mind that our nannies are solely responsible for the children and not housework other than the child’s laundry, food preparation and tidying up their toys.
Do you require a nanny who drives?	Yes No
Do you require a nanny to do your errands?	Yes No
Do you have a vehicle for the nanny?	Yes No
Do you require a nanny to have their own vehicle to transport the children?	Yes No
Do you require a nanny who swims?	Yes No
Would you hire a nanny who smokes?	Yes No
Do your children have any special food or religious considerations that the nanny should be aware of?	Yes No
If yes, please explain:

For Companions:

Do you require a companion who drives?	Yes No
Do you require a companion to transport the elderly in their car?	Yes No
Do you require a companion to run errands?	Yes No
Do you require a companion who swims?	Yes No
Do you require a companion to lift the elderly?	Yes No
Does the companion have to clean up or do laundry, dishes, house chores, etc.?	Yes No
Does the companion have to prepare meals?	Yes No
Will the companion have any down time?	Yes No
Would you hire a companion who smokes?	Yes No
Please list any special food, allergies or conditions that the companion would need to know before hiring:
Any additional comments or concerns?

For House Sitters & Pet Sitters:

House Sitters usually water all plants inside and out, help take care of your pets, change the litter box, bring in the mail everyday and stay over night to make sure that the house is safe and secure. Pet Sitters usually walk all dogs, change the litter boxes, give special medications & shots if needed, clean up after the animals, clean bird/ferret/rabbit/hamster cages and will also bring in your mail everyday.

Please list all duties & responsibilities for the pet/house sitters:

Please let us know if there are special medications or shots that need to be given to your animals:

Any additional comment or concerns?

**For Live-In Nannies, Companions & Housekeepers Only**:

Would the nanny have his/her own:

Entrance?	Yes   No	Bedroom?	Yes   No
Bathroom?	Yes   No	Kitchen?	Yes   No
Television?	Yes   No	Phone Line?	Yes   No
Computer Access?	Yes   No

Work Schedule: When would you like the nanny, companion, housekeeper to start work?

Our nannies, companions, & housekeepers usually work 8 hours a day + 5 days a week, Additional hours and or days should be discussed with the nanny prior to hiring + compensated extra for their time. What schedule would you like your nanny, companion, housekeeper to work?

Monday:        Tuesday:        Wednesday:        Thursday:        Friday:        Saturday:        Sunday:

Benefits: Usually our nannies, companions & housekeepers, receive 1 week paid vacation after 6 months of employment + paid holidays and sick days, however this should be discussed with the nanny before hiring. Will you provide any of the following benefits?      Health Insurance?      Dental Insurance?      Paid Vacations?      Paid Holidays?      Sick Days? Rate of Pay you are offering:        Salary?   -or-   Hourly? How often will the employee get paid?      Daily?   Weekly?   Bi-Weekly?

Will the employee be responsible for their own taxes or will you take out extra money to cover their taxes from their paycheck?      Yes, We'll Take Care of the Taxes      No, The Employee Will Be Responsible For Their Own Taxes Do you require your nannies, companions & housekeepers to sign a length of commitment for at least one year?   Yes   No Would you like your employee to travel with you?   Yes   No If yes, will you be paying them extra for traveling?   Yes   No Do you have any pets?   Yes   No Children's or Elderly's Likes/Dislikes: Additional Comments or Concerns: I understand that I will have to pay A-1 Perfect Nanny Service, Inc. a placement fee if they find a nanny, companion, housekeeper, pet/house sitter for our family. A-1 Perfect Nanny Service, Inc. works 24-7, after receiving the inital deposit to ensure your satisfaction in providing you with the perfect person for you & your family. If at any time you decide not to utilize our services, you will be responsible for 50% of our referral fee. I understand that I can not hire anyone unless the nationwide search has come back completed with no record found. Yes,  I Agree to these terms   Yes, I agree to these terms