Boca Nannies
&
Caretakers
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Caregiver Request Form
Please complete this form regarding your needs for a caregiver. These details, along with a personal interview, will help us find the right person for you and your family.
Contact Details
Full Name
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Phone Number
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Home Address
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City
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State
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Zip Code
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E-mail
*
Caregiver Qualifications & Work Details
Other addresses caregiver may need to go (if applicable)
Job Description (Tell us what is important to you and your family. Include all aspects of childcare. For example, name the people to be cared for, their needs, ages, any special requests (physical, educational, emotional, behavioral, other) and their schedules.)
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Days and Hours (What days do you need help? Specific schedules or number of hours?)
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Budget for Caregiver Salary (Provide a range)
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More Details About The Job
Is car provided?
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Yes
No
Does the Caregiver need own transportation?
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Yes
No
Schedule of Position:
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Full Time
Part Time
Live In
Live Out
Live Out (stay over when needed)
Type of Position (check all that apply):
Nanny Only
Nanny / Housekeeper
Household Manager
Estate Manager
Housekeeper / Child Care
Housekeeper / Adults Only
Elder Care
Mother's Helper
Chef or Cook
Other
Indemnity Agreement
IMPORTANT Terms & Conditions
I have read and agree to the Indemnity Agreement and Important Terms & Conditions.
*
Please Sign Below:
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Clear Signature
Submit Request