TYLER NANNY SERVICES
Phone: 800-840-1817

"Exceptional Childcare for Busy Families"

Family Application: Nanny/ Mother’s Helper / Permanent Nanny / Governess

Note: To protect your privacy this form is sent via secure transmission

Family Last Name   Home Number   Home Fax

Name, address & contact information must be provided in order to submit this form

Mother’s Name    Email Address

Home Address City State  
Zip

Occupation Employer

Address City State  
Zip

Work Phone   Work Fax Cell Number

Father’s Name    Email Address

Home Address City State  
Zip

Occupation Employer

Address City State
Zip

Work Phone   Work Fax Cell Number

Child's Name DOB Gender List Any Special Needs or Allergies
Boy    Girl
Boy    Girl
Boy    Girl
Boy    Girl

Desired Start Date:

Days & Hours Nanny Is Needed
Will Weekends Be Required?
Monday      Every Weekend  Yes    No
Tuesday      Occasional Weekends  Yes    No
Wednesday Saturday Hours      
Thursday    Sunday Hours        
Friday         

Family Application: Nanny / Mother’s Helper / Professional Nanny / Governess
What Do You Plan On Paying Your Nanny? $ per

Benefits
INDUSTRY STANDARD: 2 weeks paid vacation (you determine probation period – 3,6, or 9 months), 6-8 paid holidays (if required to work – then double time), 2-3 sick days, $.40 gas mileage reimbursement (covers all wear/tear on vehicle – oil changes, tires, gas, etc.) Gas mileage reimbursement does not apply if you are providing the vehicle & gas.
Paid Vacation (# of days)

Paid Holidays (# of days)

Paid Sick Days (# of days)
Bonus List, When: (B-day, Christmas, Annual)

Insurance, What Type: (Dental, Medical)

College Course How Much:

Will Driving Be Required?
Yes No 		Will You Provide A Vehicle?
Yes    No 		Gas Allowance?
Yes    No
How Often Will Your Nanny Be Required To
(Mark Appropriate) 		Never Sometimes Always
Cook For Children
Run Errands
Wash Child’s Laundry
Cook For Adults
Grocery Shop
Wash Adult’s Laundry
Feed Pets
Unload/Load Dishwasher
Travel
Assist With Homework
Child Related Event Planning
Purchasing Children’s Clothes

List in DETAIL What Housekeeping Duties Will Be Expected Of The Nanny:

Do You Have A Housekeeper?
(If yes, how often does housekeeper work?)

Yes No
Do You Have Any Pets?
 (If yes, describe)
Yes
No
Are You Expecting?
 (If yes, what is your due date?)
Yes
No
Will There Be A Stay At Home Parent?
   (If yes, who?)
Yes
No
Are There Firearms In The Home? Yes   No
If yes, are they locked and secure? Yes    No
What Type Of Discipline Methods Are Used In Your Home?

What Qualities In A Nanny Are Most Important To You?

Need Nanny to work (Check all that apply)

Summer (3 mo. or less)
Night Nanny (Newborns)
Will This Be Your First Nanny? Yes No
Would You Allow A Nanny To Bring Her Child?
If yes, Conditions: 		Yes No
How Did You Hear About Us?      
Pregnancy Guide
Were you referred to us? (If so, please tell us who to thank for the referral.)
List All Other Agencies You Are Working With
Will you be checking the nanny's references?  (Please be assured that Tyler Nanny Services ALWAYS checks ALL references.). If yes, we can provide questions to help you.
Yes    No   Sometimes         Initial Here
What Time Of Day Can Our Nannies Call You?    A.M.    P.M.
Have You Or Any Of Your Immediate Family EVER Been Convicted Of A Felony? Yes    No
If yes, Explain
Please provide a name and phone number of a nanny or childcare provider who has cared for your children
References      
Name City, State Phone Number Years Known

FRIEND OR RELATIVE TO CONTACT IN CASE OF AN EMERGENCY:

Name    Relationship    Phone Number

Location of your home
Name two major cross streets near your home
North/South Street

East/West Street

Tyler Nanny Services will begin the search for candidates upon receipt of this completed form and payment of fees has been guaranteed. All fees are non-refundable. The membership fee is due when the interview is set up or services are provided.

Payment Method

VISA     MasterCard   Discover   American Express

Cardholder Name Credit Card Number

Expiration  Month: Day: Year:

Tyler Nanny Services
Family-Agency Agreement

This Agreement is made this: Day: Year: , between Tyler Nanny Services, hereinafter called “Tyler Nanny Services”, and the Client.

Please Check Each Paragraph Box To Indicate You Have Read & Understand It

1.The Client will provide Tyler Nanny Services with a written and reasonably specific list of job duties and expectations of the nanny (Family Application). Tyler Nanny Services will endeavor to identify and refer nannies, which meet the criteria of the Client, which have been identified in the Family Application.

2.Upon request of the Client, Tyler Nanny Services will facilitate the discussions between the Client and the nanny applicant concerning employment terms. These discussions may include, but are not limited to, the topics of compensation, work schedule, vacations, duties, benefits, and other matters that might be contained in a work agreement between the Client and the nanny applicant. .

3.It is understood and agreed that Tyler Nanny Services is not the Employee or the Employer in this agreement. The Client's selection for employment of a nanny will be coupled with Tyler Nanny Service's assistance in helping you, the Client, in defining your relationship with the nanny.

4.The Client agrees to pay Tyler Nanny Services the $150.00 application fee plus half of the placement fee in the amount of $900.00 when the application is completed and submitted to Tyler Nanny Services. The $900.00 balance of placement fee shall be paid in full to Tyler Nanny Services when the formal offer is made to the nanny applicant. (ALL FEES ARE NON-REFUNDABLE) You are welcome to pay your fees via cash, personal check, or cashier's check. Your nanny can begin employment once your check has been cleared.

5.If payment is not received by the date required in this agreement, the Client agrees to the imposition of a LATE PAYMENT CHARGE by Tyler Nanny Services at the rate of 1.5% per month, or the maximum allowed by law, on the unpaid balance, along with Tyler Nanny Services, costs of collection, including attorney's fees & court costs. The Client also agrees that if the placement fee is not received by the date required, Tyler Nanny Services may, at its discretion declare this contract null and void, and any monies collected from the Client will be deemed non-refundable.

6. GUARANTEE: Tyler Nanny Services, will make every reasonable effort to secure satisfactory nanny applicants for the Client. In the event that the employment of a permanent nanny, secured with the assistance of Tyler Nanny Services is terminated prematurely, Tyler Nanny Services will replace the nanny one time during the first 6 months at no additional charge.

Tyler Nanny Services will make only one replacement referral free of charge under the ninety-day guarantee. HOWEVER, SHOULD TERMINATION OF EMPLOYMENT OCCUR BY REASON OF MISDESCRIPTION OR MISREPRESENTATION CONCERNING THE DUTIES, COMPENSATION OR TREATMENT OF THE NANNY APPLICANT OR IF YOU REFUSE TO SIGN A WORK AGREEMENT OUTLINING THE NANNY'S WORK HOURS, PAY AND DUTIES, THIS REPLACEMENT CLAUSE IS VOID AND WILL BE CONSIDERED A BREACH OF CONTRACT BY THE CLIENT.

7.The Client shall, at all times, have the right to refuse hiring any candidate being considered during the placement process. The Client understands that the nanny applicant alone is responsible for her/his actions; that the nanny applicant is not an employee of Tyler Nanny Services and Tyler Nanny Services assumes no responsibility for any act or omission of the nanny applicant either prior to or after employment with the Client has commenced. The Client understands and agrees that although Tyler Nanny Services has assisted the Client in referring a nanny or child caretaker to work in the Client's home, Tyler Nanny Services cannot predict the candidate's future behavior or performance and only the Client can assess the nanny's competence and appropriateness for the Client's position. The Client also understands that she/he takes full responsibility for the decisions to hire and to continue to employ the nanny and that the role of Tyler Nanny Services limited to supplying applicants for the Client's consideration and performing background checks on the hired applicant. All background checks are available to Client.

8.Tyler Nanny Services agrees to perform a driver's license check, a social security trace, past address history, criminal background check, and a sex offender check.

9..The Client will receive one drug test free of charge to use at any time during the term of the nannies assignment. This may be used at the beginning of employment or at anytime you wish. The client needs to call our office to schedule this.

10.Tyler Nanny Services cannot be a guarantor of the honesty or reliability of the nanny nor is Tyler Nanny Services an agent of the nanny or vice versa. Accordingly, the Client hereby releases and agrees to hold Tyler Nanny Services, its directors, officers, employees, successors, and assigns, harmless from any act of nonfeasance, misfeasance, or malfeasance by the nanny, nor will the Client hold Tyler Nanny Services, its directors, officers, employees, successors, and assigns, liable for any other claim which she/he may have.

11.The Client agrees to fully indemnify and hold Tyler Nanny Services, it directors, officers, employees, successors, and assigns, harmless from any and all claims, demands, losses, liabilities, damages or expenses for investigation or attorney's fees arising out of, or in any way related to, this agreement, including any personal injury or property damage.

12.The Client understands that the long-term employment relationship is strengthened by weekly, as well as daily, discussions between the nanny and the supervising parent, and agrees to assume all supervisory responsibilities regarding the performance of the nanny candidate.

13.Tyler Nanny Service's placement fee includes assistance in developing the Work Agreement. As the nanny's employer, you, the Client, are solely responsible for any income tax withholding, FICA payments, as well as any additional taxes or insurance payments required by law.

14.The Client agrees to refrain from making any private agreement with the nanny candidate or from taking any action which is inconsistent with this agreement or which has the effect of avoiding any of the Client's obligations hereunder. Such private agreements and actions include, but are not limited to, actions that would enable the Client or any other person to avoid payment of the registration and/or placement fees due to Tyler Nanny Services. (For example, if the Client gives the name of the nanny or a friend of the nanny to another person who subsequently employs the nanny or a friend of the nanny.) If the Client or any person known to the Client offers a nanny or a friend of the nanny a position trying to avoid the placement fee, there will be a $5000.00 charge for liquidated damages EVEN if the nanny declines the offer.

15.If the Client decides to employ a nanny obtained with the assistance of Tyler Nanny Services, the Client understands and agrees that the nanny will not start to work until all fees owed to Tyler Nanny Services are paid in full or unless a prior written agreement has been made between the Client and Tyler Nanny Services.

16.This Agreement contains the entire agreement between Tyler Nanny Services and the Client, and no statements, promises, or inducements made by either party or agent of either party that is not contained in this written Agreement shall be valid or binding; and this contract may not be enlarged, modified, or altered except in writing, signed by the parties herein.

17.It is understood and agreed that if any part, term or provision of this Agreement is held by a court to be illegal or in conflict with any law of the State of Texas the validity of the remaining terms of this Agreement shall not be altered, and the rights and obligations of the parties shall be construed and enforced as if the contract did not contain the part, term, or provision held invalid.

18.This agreement will be binding only upon the parties herein and shall not include any third party nor shall Tyler Nanny Services be a party to any agreement entered into between the Client and the nanny.

Client’s Name