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Application Date
Mother's Name
Work Hours
Place of Employment
Work Phone
Work Fax
Cell Phone
E-mail address
Father's Name
Work Hours
Place of Employment
Work Phone
Work Fax
Cell Phone
E-mail address
Home Address
Home Phone
Where to you wish to be reached?
Mother’s work
Father’s work
Mother's cell
Father's Cell
What is usually a good time to reach you?


Please describe your children:
Name Birth Date Gender School/Hrs
Please note any special needs
Other members of household (relatives, domestic help, older siblings etc.)
Name Age Relationship to Applicant
How did you hear about Monticello Nannies?
(Please update Monticello Nannies regularly with new children, addresses, phone numbers, credit card numbers and pets.)

(this is preliminary info only, you and your Nanny will be asked to sign a contract outlining the details of your agreement before employment begins)
What position do you have available?
permanent full time
permanent part time
full time live-in
Full-time Mom Nanny
Part-time Mom Nanny

(Mom Nannys bring their own child to work and earn a lower salary)
Nanny start date

PART 4: Monticello Nannies Client Understanding and Release:

Initial Understanding Between Parties:

Client desires to hire an in-home child care provider for a term of 1 year.  Monticello Nannies is a nanny referral agency and desires to assist Client in recruiting, screening, and qualifying candidates to serve as a nanny for Client.

A $200 (live-out), $250 (live-in) non-refundable Application Fee is due following the drawing up of a detailed service agreement that has been discussed and signed by both parties.  This Application Fee is a credit toward the referral fee that Monticello Nannies collects upon a successful placement. 

Monticello Nannies agrees to use all reasonable efforts to recruit and qualify nanny candidates in a timely manner on behalf of the Client.  Monticello Nannies will submit candidates’ portfolios for Client to review.

Monticello Nannies agrees to disclose all material information about our nannies acquired by Monticello Nannies throughout the qualification process. Any nanny who is referred by Monticello Nannies has met or exceeded the requirements set forth in the qualifying process.

Upon Client’s request, Monticello Nannies will provide information and practical paperwork to assist Client in their evaluation of nanny candidates, including interview questions, employment contracts, negotiating tips, sample job descriptions and more.  Upon Client’s request, Monticello Nannies will provide referrals to experts regarding household employment payroll and tax information.

The parties agree and acknowledge that any nanny hired by the Client will be an employee of the Client. 

There will be a trial period for the first nanny candidate Client accepts through the services of Monticello Nannies and the term of this period is thirty (30) days.  The purpose of this trial period will be to ensure that Client and the nanny candidate are a good match.

If, at any time during the trial period, either Client or the nanny terminates the agreement, Client will be entitled to have Monticello Nannies conduct one (1) repeat search for a substitute nanny candidate at no additional charge. 

Client may request a replacement nanny after the trial period ends, but within six (6) months after the nanny starts service and receive a reduction by fifty percent (50%) of the regular referral fee.

Other options for replacement will be outlined in detail in the final services agreement. 

Nannies must be contracted through the Monticello Nannies office. Client agrees that s/he will not hire or refer a Monticello Nannies caregiver to a third party without the consent of the Monticello Nannies office.

Likewise, Monticello Nannies will not disclose to any third party, other than as necessary to perform services pursuant to the services agreement, any personal or identifying information provided to Monticello Nannies by Client. 

Client agrees to forever indemnify, release and hold harmless Monticello Nannies caregivers, as well as Monticello Nannies, its agents, employees, and officers for any and all claims relating to services provided by caregivers. 

By clicking "I Agree" below, the client agrees to the above terms and conditions.

I agree with the terms above
I do not agree with the terms above


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•288 Fieldstone Drive, Keswick, Virginia 22947
Phone: 434-923-0023 • info@monticellonannies.com