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NANNY/CAREGIVER REFERENCE INVESTIGATION
POLICIES, STIPULATIONS & ORDER FORM

By your signature on the form requesting our nanny/caregiver reference investigation services, you agree that you have read, understand, and accept the following policies and stipulations.
 

· Legal Services:  The Nanny Reference Clinic and its parent L.D.A. Enterprises, Ltd. is not a law firm, nor do we employ attorneys.  However, we will be available on a for-fee basis to provide certain services to you or to the attorney of your choice.  These services may include written or in-person depositions or providing expert witness testimony.  Fees for these services are listed under our optional services and support fees section.
 
Time required for completion:
 
We cannot guarantee a specific time frame for the completion of your nanny/caregiver reference investigation.  Most investigations can be completed and a report sent within 7 business days.  However, since all references are obtained by direct phone conversation we cannot be responsible for those individuals who do not respond to our attempt at contact.  The contact may be traveling, on vacation, or simply avoiding our phone calls.  Therefore, we will ask you to provide at least one alternative contact, and guarantee that under any circumstances we will send your report by email, or if requested by first class U.S. mail as soon as it is available, or at most within 2-weeks of the receipt of your prepaid order.  The report will contain the complete documentation of our reference checking efforts, or it will show that the contact(s) you provided were not available or non-responsive to our efforts to speak with them.  In either case we will include, along with our report, a copy of your free “ nanny guide” as indicated on our nanny reference verification web pages.
 
Statement of Confidentiality:
 
All information provided by you or any member of your family will remain totally confidential.  It is important to understand that your information is totally secure with us.  L.D.A. Enterprises, Ltd. does not sell lists of clients or in any other way disseminate personal information provided by our clients to any third party or organization for any reason without your prior written consent.
 
Accuracy of Information:
 
We do our very best to assure the accuracy of all information gained through our reference investigations.  However, we are not responsible for any inaccurate, untruthful, or misleading information conveyed by the individuals providing references nor are we responsible for conducting criminal background investigations.  Therefore you agree that reference clinic.com is to be held harmless and incur no liability for damages done, theft committed, or any other adverse consequence resulting from a decision to hire any individual(s) based upon information contained in our reference investigation report.  We do not either advocate or discourage the hiring of any individual.  We are merely a conduit of information to assist you in reaching your best hiring decision.
 
Refund Policy:
 
The Reference Clinic cannot be responsible for contacts that do not return our calls or repeated requests for information.  You as the client have an obligation to furnish us with accurate contact information so that we can reach the individual(s) who will be providing the reference(s) for your nanny applicant(s).  Therefore, if the contact does not return our calls after multiple attempts within 7 business days, we will document our efforts and mail your final report.  Because we do guarantee to extend our maximum effort to satisfy you as a client, and since we are also providing you with services and information that goes beyond the actual reference check, our fees or any portion of them are non-refundable.
 
 

NANNY/CAREGIVE REFERENCE VERIFICATION ORDER FORM

 

 All information you provide is considered completely confidential and will not be released to any third party or organization without your written consent.

 

 

Please fill out and submit one form for each individual reference you need verified.

 

TO ORDER: You may copy and paste the following order form into an email, cut it out and fax it to the number listed below, or send it by regular U.S. mail to the address indicated.

 

 

ReferenceClinic.com                                                Phone: (952) 697-3663

L.D.A. Enterprises, Ltd.                                            Fax: (952) 697-3667

Parkdale Plaza, 1660 South Hwy 100, Suite 500

St. Louis Park, MN 55416

Email: References@EmploymentClinic.com

  

All information you provide is considered completely confidential and will not be released to any third party or organization without your written consent.

 

Your Personal Information:

 

Name (Mr. or Ms.): __________________________________________________________

 

Address: ___________________________________________________________________

 

City: ____________________________________ State: ________ Zip Code: ___________

 

Home Phone: ________________ Business Phone: _________________ Fax: _________________

 

Email: ____________________

 

Nanny/caregiver candidate’s personal information:

 

Name of the nanny/caregiver candidate: ________________________________________________________

 

Social Security or ID number of the nanny/caregiver candidate (if available): __________________________

 

Current Address of the nanny/caregiver candidate: _______________________________________________

 

City: ____________________________ State: _____________ Zip Code: _______________

 

Home Phone of the nanny/caregiver candidate: _________________________

 

Referring Agency (only if referred through an agency):

 

Agency Name: __________________________________________________________

 

Address: _________________________________________ Agency Phone: ____________________

 

City: _______________________________ State: ___________ Zip Code: _____________

 

Contact Name: _______________________ Contact Title: ___________________________

 

 

 

Please fill out the following information for each reference you wish checked

 

 

The nanny/caregiver candidate’s employer contact information:

 

Male head of house: Mr. _________________________________________________

 

Work Phone: _______________________ Email address: ______________________

 

Female head of house: Ms. or Mrs. _________________________________________

 

Work Phone: _______________________ Email address: ____________________

 

Address: __________________________________________________________

 

Home Phone: ________________________

 

Number of children cared for: ______________________

 

What were the dates of the nanny’s employment: from ______________ to: _______________

 

Is she still employed? If not, why did the nanny leave her last employer?

 

_________________________________________________________________________________

 

Agreement Statement:

 

By your signature below you acknowledge that you have read and agree to the policies and stipulations as published on our Reference Checking Policies and Stipulations webpage and authorize The Reference Clinic and its employees or agents to contact the above named nanny employment references and/or referring agency.  You agree that we are not responsible for any inaccurate, untruthful, or misleading information conveyed by the individuals providing references nor are we responsible for conducting criminal background investigations.  Therefore, you agree to release and hold harmless The Reference Clinic and its employees or agents for damages done, theft committed, or any other adverse consequence resulting from a decision to hire any individual(s) based upon information contained in our reference investigation report.  Although we do our best to provide timely information and in most cases can provide a completed report within 7 business days from the time we receive your order, you agree that The Reference Clinic cannot give any guarantees regarding the exact time frame in which results can be provided.  However, under any circumstances we will complete our report with 2-weeks of the receipt of your prepaid order.  You further agree that fees paid are not subject to refund once a reference investigation has been initiated. 

 

                            Order Information – please select your service:

 

     One comprehensive nanny/caregiver reference investigation - $179.95

(Agency reference investigations are conducted at the same price)

 

     Two or more comprehensive nanny/caregiver reference investigations - $174.95 each

 

Quantity ordered ___________   Total amount: $__________

 

  • Unless otherwise requested, reports will be emailed to your provided email address and a hardcopy will follow by 1st Class U.S. mail if requested.

 

Optional services and support fees (applies to all reference checking investigations).  Fees for other services appear on our ReferenceClinic.com home page and include expert witness testimony and deposition charges.

 

The following charges are in addition to all fees quoted above.  Please check applicable boxes.

 

 

  • Reports sent by email or by 1st class U.S. mail - Included
  • Faxed reports - $15.00 per report
  • Reports by telephone - not available
  • Notarized affidavits sent by U.S. mail - $15.00 per report
  • Canadian reference investigation report - $15.00 per report
  • Telephone depositions - $250 per hour (1-hour minimum)
  • Expert witness testimony or in-person depositions - $1,850 per day, per person attending (one-day minimum) Plus all applicable expenses.
  •  

     

    Total cost of optional services (if any)                              $____________

     

    Total charges including optional services                    $____________

     

     

    Please check one: Visa ____ MasterCard ____ American Express ____ Check ____

     

    Card number: __________________________________ Expiration date: ____________

     

    Charge card security code ________ (last 3 numbers on the back of your Visa or MasterCard typically on the right hand side of the signature strip) or (the 4 number code on the front of the American Express Card, on the right hand side just above your card number.)

     

    Cardholder’s Name (exactly as it appears on the card): _________________________________

     

    Billing address of the cardholder: __________________________________________________

     

    City: _________________________ State: __________ Zip Code:  ________________

     

    Signature: ____________________________________ Date: _______________________

     

     

    You may pay check, Visa/MasterCard, or American Express.  If you are paying by check, your check and authorization form (this form) should be signed and mailed to the address below.  If paying by credit card, you may also email or fax the completed and signed forms to our secure fax line: (952) 697-3667, attention Edna Campbell. 

     

    L.D.A. Enterprises, Ltd.

    Parkdale Plaza, 1660 South Highway 100, Suite 500

    St. Louis Park, MN 55416

    Attention: Edna Campbell

     

    Email address: References@EmploymentClinic.com

     

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