Midwest Nannies Florida: Child Care Providers Temporary and Permanent

Member of the Greater Fort Myers Beach Area Florida Chamber of Commerce

Application for Temporary Service

Please do NOT print out this form,
it is for online submittal only.

Since your privacy is of utmost importance to us, this application form is hosted on a secure server and all data sent to us is encrypted.

Thank you for your interest in Midwest Nannies Florida. We are pleased to help you with your child care needs. By completing the application below we can begin the process of introducing you to nannies in our pool of candidates. We will need a signed Placement Agreement as well.

For a printable version of the Placement Agreement for a temporary Nanny, click here. PDF format, requires Adobe Reader

You can download this placement agreement and fax the form directly to our office or a Midwest Nannies Counselor will call you upon receipt of this application online. We look forward to working with you and guiding you through the hiring process.

Job Order - Temporary Clients
Contact Information
Client Name:
Spouse's Name:
Home Telephone:
Home Fax #:
Father's Work Phone:
Father's Work Fax:
Mother's Work Phone:
Mother's Work Fax:
E-mail address:
Address:
City:
State:
ZIP Code:
Major Cross Streets:
Care is for:
First Child's Name:
Date of Birth:
Special Needs (i.e. physical disability, behavioral concerns, medication, allergies, etc.)
Second Child's Name:
Date of Birth:
Special Needs (i.e. physical disability, behavioral concerns, medication, allergies, etc.)
Third Child's Name:
Date of Birth:
Special Needs (i.e. physical disability, behavioral concerns, medication, allergies, etc.)
If you have more than three children, please enter the additional information here:
Do you have any pets in/out of the home:	Yes No
Please describe your pets:
Job Description:
Dates Care Needed
To Be Determined	Yes No
Specific Dates: (please enter the dates and the "from and to" times needed on each date)
Ongoing Temporary Schedule: (please enter "from and to" times needed on each day)	Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Any special instructions:
Caregiver Profile
Please indicate by marking the following questions if you have a preference.
Allow nanny to bring own child?	Yes No
Non-Smoking household ?	Yes No
Non-Smoking caregiver?	Yes No
Need own car on job?	Yes No
Will supply car on job?	Yes No
Swimmer?	Yes No
Additional Caregiver Profile:
AGENCY POLICIES
A $30.00 First day agency fee is due upon receipt of paperwork for all childcare, new mother/baby care, and all overnight extended care jobs. This First day agency fee will be charged every year to continue service. The Agency charges a $15.00 per day agency fee for each day a caregiver is referred. A Temporary Placement Agreement will be enclosed and should be signed and returned to the office. Caregivers cannot leave their telephone number, but can be contacted through the Agency. All Placement Fees owed Midwest Nannies Florida are due and payable prior to Nanny's first day of employment. The Placement Fee referenced in this Agreement will automatically be charged to Client's credit card account. The Client must provide to Midwest Nannies Florida a valid credit card number, including the 3 digit security code and expiration date, as a guarantee of payment. Client hereby authorizes Midwest Nannies Florida to place charges on said Account in accordance with this Agreement.
"I have read, understand and agree to the Agency Policies as stated above."
I agree	I disagree

Serving all of Southwest Florida

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“My experience was a very pleasant one. I needed a nanny quickly and Midwest Nannies Ltd. sent me candidates within a few days. I interviewed and hired C. within three days of my request. In addition, they provided me via fax all information they had on my new nanny. The family packet was also a great tool. Thanks so much for your help.”

phone
(239) 463-4774

fax
(239) 463-4774

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