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EMPLOYMENT APPLICATION

PERSONAL INFORMATION
List Job Applicant's Name: GLORIA S
List Home Address: Potomac , Maryland 20854
List Home Phone #: Withholding for now
List E-mail Address: N/A

GENERAL INFORMATION
Are you 18 years or older? Yes (Mid 50s)
If employed, could you submit proof of your legal right to work in U.S. to your employer (Exp. a Resident Card, Work Permit or Student Visa)? Yes - Permanent Resident holder
Do you have at least two years of recent experience as a nanny or domestic worker? Yes
Do you speak English? Yes
Do you speak a fluent language other than English and if so, please list language(s)? Portugese and some Spanish
Do you have a driver's license and do you have your own vehicle? Yes to both questions
If applicable, list the state you have your driver's license and the expiration date: Maryland
List driving violations and dates if applicable: None over the last 8 years
Do you wish to drive child/ren or adult in your vehicle while they are in your care? Yes, but will need additional pay on top of reg. weekly salary for gas expense
If yes, do you have adequate vehicle insurance? Yes
Do you prefer your employer provide you with a vehicle for job-related duties? Yes
Are you CPR certified for infants/children or adults and if so give us the certification exp. date? Non certified Are you a smoker or a non smoker? Non smoker
If applicable, please let us know how many children you will care for and their ages? 1 or 2 ages, newborn up to teen years
Do you need to bring your child to work with you and if so, please list your child's age? No, son is in his 20s in college
For elder care or companion care candidates, please briefly describe what you are looking for. Care for an elder or couple who need personal care, house up keep, etc.

DESIRED EMPLOYMENT
List the type (Nanny, nanny/housekeeper, housekeeper, day worker, elder care, companion care or other) of employment needed and let us know if you are available for full-time, part-time, live-in or out, short or long-term or a Summer position

Housekeeper, cook, caretaker (oversee home/property), housekeeper/nanny/cook, part-time, live-out and long-term employment

EMPLOYMENT AVAILABILITY/RELOCATION INFO
If hired, when can you start work? Any day (Need to work asap)
List the days/hours you are available for work: Monday through Friday after 3:00/3:30 p.m. up through 7:00 p.m. or later if needed
List locations you are willing to consider for work: Maryland areas including Bethesda, Chevy Chase, Gaithersburg, Germantown, Potomac and Rockville - NW-DC area
Can you work overtime, if needed? Maybe - will discuss at interview
Do you want to relocate for work in the U. S. and if so, list locations you will consider for employment? No
If applicable, are you willing to pay travel, lodging & food expenses as part of your relocating costs? No

DESIRED SALARY & EMPLOYEE BENEFITS
List salary expectations for hourly work schedule: A minimum of 20 hours/week for part-time help at $20/hour per week - May consider 15/hours/week at $20/hour
List duties you will perform: General housecleaning, laundry, cooking, running errands, as needed child care for one or two children, and/or overseeing home/property as a caretaker
List desired benefit's package: If offered, paid federal holidays, two week's paid annual vacation
If applicable, list live-in accommodations you will consider: N/A

EDUCATIONAL BACKGROUND INFORMATION
Did you graduate from high school in the U.S.? No
If you went to school in a country other than the U.S., indicate country: Portugal
Did you graduate from college: No
List the year you graduated: N/A
List the area of study and the type of degree you have: N/A
List the location of the educational institution? N/A
Are you currently a student? No
If so, please list your area of study, the days and hours of your classes: N/A
Please list a person's contact name and phone number in case of an emergency: Name/Phone #: Withholding for now
Have you ever been convicted of a felony? No

WORK REFERENCES

Applicant Name: GLORIA S.

LIST WORK REFERENCES (List most recent employer first)

(1) LIST THE NAME OF YOUR EMPLOYER: MR. ALAM C.
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION (list city/state only): BETHESDA, MD
LIST DATES WORKED: 2004 - 2009 (PART-TIME, FLEX. HOURS)
LIST YOUR JOB TITLE: HOUSEKEEPER/HOUSE MANAGER/COOK (While employer is at his residence in Bethesda) CARETAKER OF HOME/PROPERTY (While employer visited his other home in Boston)
LIST JOB DUTIES: Housecleaning, laundry, cooking meals, tending to home/property (light duties) while employer visiting other home in Boston
LIST CHILDREN'S AGES: N/A
WHY DID YOU LEAVE THIS JOB? No longer needed for weekly regular housecleaning/cooking duties, but she will continue staying on as the employer's caretaker of home/property during his absence.
EMPLOYER'S COMMENTS: Talked to Mr. C. on 2-3-09 - He gave Gloria an excellent work recommendation commenting on she is very trustworthy, reliable and a hard working individual. Her current job with Mr. C. involves her working as his housekeeper/cook while he is at his residence in Bethesda, working in a part-time work capacity. She is his housekeeper/caretaker of his home/property in Bethesda while he is away at his other home located in Boston, Massachusetts.

(2) LIST THE NAME OF YOUR EMPLOYER: SUZANNE B.
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION (list city/state only): BETHESDA, MD
LIST DATES WORKED: 1998 - SEPT. 2008
LIST YOUR JOB TITLE: NANNY/HOUSEKEEPER
LIST JOB DUTIES: Cared for one child, age 5 years up to teen years (child is now 16 years), driving child to/from school/activities and when not tending to the child's needs helped out with housecleaning, laundry and ironing
LIST CHILDREN'S AGES: 5 years up to 15 years
WHY DID YOU LEAVE THIS JOB? Job ended and no longer needed help - Mother stays at home now and the child no longer needs a nanny.
EMPLOYER'S COMMENTS: Talked to Suzanne B. on 1-30-09 - She highly recommends Gloria as a nanny (the best nanny ever in her words) and as a housekeeper. She will continue to stay in touch with Gloria on a very friendly basis.

(3) LIST THE NAME OF YOUR EMPLOYER: SELMA S.
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION (list city/state only): BETHESDA, MD
LIST DATES WORKED: 1998 - NOV. 2008
LIST YOUR JOB TITLE: HOUSEKEEPER
LIST JOB DUTIES: Housecleaning, laundry and ironing
LIST CHILDREN'S AGES: N/A
WHY DID YOU LEAVE THIS JOB? Job didn't allow enough hours so Gloria had to find her another job and the family
hired a new housekeeper - Job ended on very friendly terms and Gloria and the family continues to stay in touch.
EMPLOYER'S COMMENTS: Talked to Selma S. on 1-30-09 - She highly recommends Gloria as a housekeeper and will continue to stay in touch with her up ahead on a very friendly basis.

Employers listed below are from late 1970s through end of 1997. We only check work references within the U.S. and dates do not exceed past 10 years from the current date.

(4) Employer
Had previously been employed 7 years as a housekeeper with the Portugese Embassy in DC This employer is no longer available for contact in DC.

(5) Employer
Had previously been employed 4 years as a housekeeper for the American Embassy in the Bahamas
This employer is no longer for available for contact in the Bahamas.

(6) Employer
Had previously been employed 6 years as a cook, housekeeper and nanny for a U.S. Senator
Dates worked from 1978 through June 1981 as his cook and from thereafter up through 1984 as his housekeeper and nanny
Duties: Assumed all household duties to include housecleaning, family laundry, ironing, cook ing, running errands (grocery shopping and child-related errands), overseeing household staff and caring for one child, age 5 years--the child is an adult now, a U.S. Congressman
Employer Comments: We have not and will not contact this employer since it has been over 10 years since Gloria had worked with this employer. However, we have enclosed a Letter of Recommendation that we have on file, dated June 10, 1981 from this senator (Letterhead displayed as United States Senate in Washington, DC) giving Gloria S. an excellent recommendation to any of her future potential employers who may want to consider her in a position as a cook. Gloria had received this letter prior to completing her employment with this employer since she worked three years more since the below letter was written.

Letter written by Senator Edward Kennedy
Date: June 10, 1981
TO WHOM IT MAY CONCERN:
This letter is to recommend Mrs. Gloria S. who has served in my household as cook for the past three years. Gloria is an excellent and creative cook. Throughout the period of her employment, she has provided the food for numerous excellent and successful dinner parties. It is a pleasure to recommend Gloria S. to any future employers.
Sincerely,

Edward Kennedy
U.S. Senator


If you would like to meet with Gloria S. in a job interview then contact our company to check to see if she is still available for employment. If she is available then we ask that you SIGN UP with our service by using our online Family Application. See below for this link. Thank you - We look forward to hearing from you!

CONTACT INFORMATION

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