We are the leading placement agency since 1995 serving Ohio, Indiana, and Kentucky!

You’re the heart
of our business

  

Contact Us

513-661-4245
Cell: 513-702-2396
Fax: 513 661 4277
ruth.hatfield@nannyplaceohio.com

Family Placement Order

We would appreciate it if you would take a few moments to answer the following questions. Please be assured that we do not share or sell personal information.

Section 1: Personal Info
Father's Name: Mother's Name
Father's Employer Mother's Employer
Father's Business Phone Mother's Business Phone
Address Line 1  
Address Line 2  
City State
Zip Code Part of Town
Email Address Home Phone
How did you know about Nanny
Placement Service?		    
When do you need a nanny or
care provider?
 
Please choose appropriate care needs:    
       
Section 2: Children      
1st Child's Name 1st Child's Age Sex of 1st Child
2nd Child's Name 2nd Child's Age Sex of 2nd Child
3rd Child's Name 3rd Child's Age Sex of 3rd Child
4th Child's Name 4th Child's Age Sex of 4th Child
5th Child's Name 5th Child's Age Sex of 5th Child
6th Child's Name 6th Child's Age Sex of 6th Child
Describe Children's Health
Briefly Describe Children's Personalities (shy, outgoing, well-rounded)
Describe The Type & Hours of School Attendance
Describe Your Approach to Child Rearing & Discipline
Describe A Typical Schedule You Would Expect A Caregiver To Follow
 
Section 3: Household
Any Other Adults In The Home Other Than Parents?
What Other Household Staff Do You Employ?
Religion(if appropriate)
Do You Have Any Pets? If yes, please describe
Is Smoking Permitted In Your House?
Is Alcohol Permitted In Your House?
What Is Your Policy For The Nanny Regarding Smoking & Alcohol Consumption In Your Home During Off-Duty Hours?
Please Describe The Rhythm Of The Household, Formal/Informal/Busy, etc
Please Describe The Community In Which You Reside Including Any Public Transportation From Your Home and Nearest Town Or City
 
Section 4: Family Interest
Please rate the following according to your importance in finding a Nanny:
Experience With Children Laundry Skills Organizational Skills
Communication Skills Neat Appearance Cooking Ability
Athletic Skills Education Able to Drive
Writing Skills Compatible Personality General Housekeeping
Creativity Music Skills  
 
 
Section 5: Interview Procedure
Is It Convenient To Interview Applicant At Your Home?
If Not, Please Explain The Most Appropriate Place For Your Interview
Will You Pay Travel Expenses Incurred During The Interview Process?
If Yes, Please Specify Any Limitations
May Applicant Speak To Your Current Or Previous Nanny?
If Hiring Involves Relocation, What Costs Will You Pay?
 
Section 6: Terms of Employment
 
How Many Hours Is The Nanny Expected To Work?
Daily hours from to
List Any Off Days During The Week
Mon Tue Wed Thu Fri Sat Sun
 
List Any Holidays Off
How Often Will You Need Nanny To Travel With You?
Please Approximate The Starting Salary For Nanny (gross/net)
If Part-Time, Please List Hourly Rate
 
Please Indicate YES, NO, or UNDECIDED As The Following Apply to Nanny
Paid Holiday Overtime Pay
Paid Personal Days Mileage Allowance
Car Insurance Paid Use of Car On Duty
Health Insurance Paid Paid Vacation
Taxes Taken Out & Paid Quarterly  
 
 
Accommodation For Live-In Nanny
If Separate Quarters From The Home, Please Specify
For Quarters In The Home, Please Check What Is Included
Private Room
Sitting Room
Bathroom
Phone In Nanny's Room
TV In Nanny's Room
Which Rooms Will Be Available To Nanny When Off Duty?
Any Additional Information?
 
Section 7: Financial Service Agreement
This Agreement is made and entered into on
by and between Nanny Placement Service, Inc., and
 
By signature below, I/we agree and understand that:
1. Nanny Placement Service, Inc. will undertake a search for prospective applicants and refer to me/us those applicants who are interested in the position.  This search shall include the names, addresses, and biographical information of the applicants who appear to satisfy my/our requirements.  Although the applicants have been screened by Nanny Placement Service, Inc., it is my/our ultimate responsibility to decide if a particular applicant meets my/our criteria and to seek out additional information about the applicant if it is needed to arrive at my/our decision.  I/We understand that the applicant’s information is strictly confidential and will be used only for the purpose of this agreement.
2. A Retainer Fee in the amount of One Hundred ($100.00 plus tax) Dollars is required at the time of the execution of this AGREEMENT for services rendered by Nanny Placement Services, Inc. This Retainer Fee is non-refundable, but is good for one year, and is applied to the total Placement Fee for those signing a full-time placement contract, to be paid to Nanny Placement Service, Inc., upon final agreement of employment. This Retainer Fee is used to cover expenses incurred in checking backgrounds and obtaining criminal and motor vehicle reports of prospective applicants.
3. Nanny Placement Service, Inc. shall not be liable for any act or omission by any applicant ultimately chosen by me/us for nanny services.  I/We expressly agree to hold Nanny Placement Service, Inc. harmless for any individual act(s) on the part of the provider placed with me/us.  I/We understand that Nanny Placement Service, Inc. is making no representations and is providing no warranties as to the fitness, ability, or character of any prospective provider.  I/We waive any claim which I/we may have against Nanny Placement Service, Inc. either now or in the future for any acts of the provider which is ultimately chosen by me/us.
4. The total Placement Fee for services (one month of the agreed upon Caregiver’s salary or $500, whichever is greater, as outlined on the website under “Our Fees”), is earned when a Nanny Placement Service, Inc. referral results, either directly or indirectly, in the employment of an applicant within one year from the initial date of referral. The entire balance of the Placement Fee, after applicable credit for the initial Retainer Fee, is due and payable three (3) days prior to the employment starting date of the Caregiver.
5. If employment is terminated by the family within eight (8) weeks of the starting date, Nanny Placement Service, Inc. will, if I/we choose, provide its services for another referral at no additional charge. If the Caregiver has to leave within one year, Nanny Placement Services, Inc. will, if I/we choose, provide its services for another referral at no additional charge. We do not refund the money, but will replace the Caregiver once the Placement Fee has been paid.
6. Nanny Placement Service, Inc. shall have the right to release information submitted in my/our Placement Order to applicants for regulatory and governmental compliance purposes.
This Agreement shall be governed by and construed in accordance with the laws of the State of Ohio, unless specifically noted otherwise.  By signature below I/we further acknowledge that I have read and understand the terms of this Agreement and agree to be bound by its terms.  I/We further acknowledge receipt of a copy of this Agreement.
I have read and agree to the terms and conditions of the Financial Service Agreement
 
Client Date
Client Date
 
I understand that the placement fee must be paid prior to the Nanny’s service and the nanny will not begin working until the fee is paid.
 
According to the application material I have read, the above has been completed accurately to the best of my knowledge.
 
Your Name:
Your Email:
Date: