Employee Nanny Statement

EMPLOYEE NANNY STATEMENT

Personal Information

Position and Terms

Employer Name:    Employer Address:

Commencement Date:    Regular Schedule (days/time):

Pay Frequency:    Overtime Rate (if applicable):

Household Provided Room & Board: (check if applicable)

Employment History (Most Recent)

Dates Employed: From to

Employment History (Prior)

Dates Employed: From to

Education

References

Childcare Details & Medical Information

Authorized to administer over-the-counter medication as directed:    Authorized to transport children in personal/household vehicle:

Health & Safety Qualifications

CPR Certification:    If certified, expiration date:

First Aid Certification:    If certified, expiration date:

Taxes, Payroll & Classification

Classification: Employee    Independent Contractor

If employee, Employer will withhold applicable taxes and make required employer contributions. If independent contractor, nanny is responsible for all taxes due. Nanny understands classification selected above and agrees to notify Employer of any change in status or documentation.

Background Check & Authorization

I authorize the Employer and its agents to contact prior employers, references, licensing authorities, and educational institutions to verify information provided and to conduct criminal background and driving record checks as permitted by law. I understand that employment is conditioned on satisfactory results.

Consent to background and reference checks:

Confidentiality & Conduct

The Nanny agrees to maintain the confidentiality of all private information relating to the household, children, and Employer personal affairs. The Nanny shall not disclose, copy, or retain any such information outside the scope of employment. The Nanny agrees to conduct duties professionally and to follow household rules provided in writing.

Termination & At-Will Employment

Unless explicitly agreed otherwise in a separate written agreement, employment with the Employer is at-will. Either party may terminate the employment relationship at any time, with or without cause, and with or without prior notice, subject to any notice period specified herein.

Emergency Authorization

In the event of a medical emergency and if the Employer or designated guardian cannot be reached, I authorize the Employer to seek necessary medical treatment for the child(ren) under my care. I grant permission to transport to the nearest medical facility and to authorize emergency medical treatment as needed.

Emergency medical authorization:

Equal Opportunity & At-Will Statement

Employer is an equal opportunity provider. Decisions relating to recruitment, hiring, promotion, compensation, and other terms and conditions of employment are made without regard to race, color, religion, sex, national origin, age, disability, or other protected characteristics. Nothing in this statement creates a contract of employment for any specified duration.

Applicant Certification & Authorization

I certify that the information provided in this Employee Nanny Statement is true, complete, and correct to the best of my knowledge. I understand that any material misrepresentation, falsification, or omission may result in denial of employment or immediate termination. I authorize the Employer to verify the information provided, to conduct background checks, and to obtain employment references. I release all parties from liability for providing information in good faith.

I agree to comply with household policies and the lawful instructions of the Employer. I acknowledge receipt of any childcare instructions provided in writing and agree to follow them as part of my duties.

Acknowledgements

I have read, understand, and agree to the terms set forth in this Employee Nanny Statement.

Acknowledgement:

Sign Now