Permanent Client Application Permanent Client Application Date* Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Mobile Phone*Home PhoneJob Description*Select all that apply Live-In Live-Out Part Time Other Other Job DescriptionWhat position are you looking to fill?*Select all that apply Nanny Housekeeper Elderly Companion Baby Specialist (temporary, 24hr or overnight care) As-Needed Babysitter Tutor Homework Helper Other Other PositionWork Schedule*i.e. Monday - Friday | 9AM - 5PMDaysTime ListChildren or elderly you need help with. Please provide name age & gender.NameAgeGender What household duties do you need to have performed? Family laundry Fold & put away clothes Iron Dishes Make beds Change Sheets Clean main living areas Clean windows Clean bathrooms Vacuum Mop Dust Maintain grocery list Grocery shop Trash disposal Wipe down counters Run errands Change diapers Cook for parents Cook for kids Bathe child Other Check all that apply. Be mindful of your needs.Other duties What employee skills do you need?Check all that apply. Be mindful of your needs Speak English Speak Spanish Own a car Drive Drive using the candidate's care Swim Wear a uniform Baby-sit in the evenings Travel with family Take care of pet Observe dietary laws Other Other skills Dietary Laws PetsNameKindResponsibilities What are your typical travel destinations? Are there any other qualifications you require? Please list any disqualifying factors. Family/Job DynamicsCheck all that apply. Both parents work Someone in the family smokes There's a separate bedroom for the live-in employee There's a separate bathroom for the live-in employee Employee has health benefits Employee has PTO Employee has paid holidays off Both parents live in the home Other Other DynamicsWhich holidays would the employee have off? Salary Range per hour/week for live-out/live-in?*Preference of Interview Times*Day(s)Times Turn By Turn Directions*To your house or interview location. Include any special parking instructions.Location of public transportationHow did you learn of Class Act Nannies, LLC?When do you need the employee to begin?*
