Temporary Client Application As needed babysitter, housekeeper or petsitter Date* Name* First Last Email* 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 Mobile Phone*Home PhoneDate & time for employee to start*DateTime Date & time for employee to stop*DateTime Date & time for employee workIf multiple daysDateTime Job Description*Select all that apply. As needed babysitter Live-in As needed babysitter Live-out As needed housekeeper Live-in As needed housekeeper Live-out Petsitter Other Other NeedAny Children?NameAgeGender Any Pets?NameBreed House Square FootageEmployee SkillsCheck all that apply. Be mindful of your needs. Speak English Speak Spanish Own a car Drive Drive using the candidate's car Drive using the client's car Swim Wear a uniform Change diapers Take care of pet Observe dietary laws Other Other skillsDietary laws Pets to Take Care ofNameBreedResponsibilities Any disqualifying factors? Family DynamicsCheck all that apply. Someone in the family smokes Separate bedroom for the live-in employee Separate bathroom for the live-in employee Other Other Family DynamicsTurn by Turn Directions*Please include any special parking instructions.Location of Public TransportationHow did you learn about Class Act Nannies, LLC?
