Nanny Application Form

Personal Information
Single   Married   Divorced   Widowed   Separated   Partner  
Yes No
Yes No

Yes No
Yes No
Yes No

Yes No

Yes No

  Accidents
  DWI/DUI
  Suspended License
  Speeding Tickets or other Moving Violations

Prospective Nanny Information
Yes No


  Full Time
  Part Time
  On Call
  Live-In
  Live-Out

  Nanny
  Housekeeping
  Baby Nurse
  Household Manager
Yes No

  West Side
  North Shore
  East Side (Windward)
  Shouth Shore (including Waikiki)

What types of tasks are you willing to perform (check all that apply):

Task
For the children only
For the entire family

What days/times are you available to work?

  Sunday
  Monday
  Tuesday
  Wednesday
  Thursday
  Friday
  Saturday

Yes No


  Infants (under 1)
  Toddlers (under 2)
  Preschool (3-5)
  Elementary School (6-12)
  Teenagers (13+)

  One child only
  Two children
  Three children
  Four children

  Multiples (twins and triplets)
  Special Needs
Education







Child Care Employment History  Note: these references will be verified 








Personal References  Note: these references will be verified 
Essay Questions








Legal

Please read the following agreement carefully before submitting this form.

This application serves as a legal agreement between Nannies Hawaii™ and Applicant (insert your name here), (hereinafter referred to as Applicant) entered into on this date (insert date here.)

Independent Contractor Status:

Nannies Hawaii™ is NOT an employment agency. Applicants will be working as an independent contractor. Since Nannies Hawaii™ is not applicant's employer, it is applicant's responsibility to report state, federal, general excise tax (required in Hawaii), as well as any other taxation required by law.

Indemnification:

Applicant agrees to release, defend, indemnify and hold Nannies Hawaii™ and employees (hereinafter collectively referred to as "Nannies Hawaii™") harmless from any and all losses, expenses, claims, costs, legal judgements, and other fees (including attorney fees) that may arise from or relate to the services provided by Nannies Hawaii™ to client and to applicant. If applicant is found negligent or accused of misconduct, applicant will not hold Nannies Hawaii™ responsible.

Covenant Not To Compete:

Applicant agrees not to work for any client referred by Nannies Hawaii™ for a period of one year after the effective date of applicant's termination (voluntary or unvoluntary) with Nannies Hawaii™. Legal action may be taken against applicants that violate this agreement.

Nannies HawaiiRole:

Nannies Hawaii™ will make every effort to find a suitable placement between applicant and potential family. Nannies Hawaii™ cannot guarantee that a placement will be made. The decision to hire the applicant is purely the clients. Nannies Hawaii™ has no part in the final hiring decision. Once an agreement is made between applicant and client, employment terms are strictly between them. Nannies Hawaii™ has no part in the final employment terms. Applicants may select or reject any placement arranged by Nannies Hawaii™.

Agreement:

Applicant acknowledges receipt of a copy of this agreement. Applicant acknowledges that they have fully read and understand each statement in this agreement. Applicant acknowledges all statements above by signing this agreement.


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