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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 *

Phone Number *

Home Address *

City *

State *

Zip Code *

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.) *

Days and Hours (What days do you need help? Specific schedules or number of hours?) *

Budget for Caregiver Salary (Provide a range) *

More Details About The Job

Is car provided? *

Yes

Does the Caregiver need own transportation? *

Yes

Schedule of Position: *

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

Important Notice

Dear Client: Some caregivers want to damage the relationship between client and the agency for their own convenience, but remember: Caregivers can come and go but the Agency will be there for you to help with your household and child care needs.

I have read and agree to the Indemnity Agreement and Important Terms & Conditions. *

Please Sign Below: *

Boca Nannies & Caretakers

Providing trusted nanny and cleaning services in South Florida since 2010.

Get in Touch

(561) 702-9431

¡Hablamos Español!

Serving: Palm Beach, Broward, & Miami-Dade

Contact Details

Caregiver Qualifications & Work Details

More Details About The Job

Indemnity Agreement

IMPORTANT Terms & Conditions

Important Notice