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FAMILIES HELP LINE - EMPLOYMENT APPLICATION

PERSONAL INFORMATION
Job Applicant Full Name: LINDA A.
Address:
Home Phone #: Withholding for now
Cell Phone #: Withholding for now
Marital Status (Not mandatory):
Number of children: One, a 4-year old
Faith or Religion (Not mandatory):

GENERAL INFORMATION
Are you 18 years or older? Yes
If employed, could you submit proof of your legal right to work in U.S. to your employer? Yes
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 the language? Yes - Indonesian and Mandarin
Do you have a driver's license and do you have your own vehicle? No
If applicable, list the state you have your driver's license: N/A
List driving violations and dates if applicable: N/A
Do you wish to drive child/ren or adult in your vehicle while they are in your care? N/A
If yes, do you have adequate vehicle insurance? N/A
Do you prefer your employer provide you with a vehicle for job-related duties? N/A
Are you CPR certified for infants/children or adults and if so give us the certification exp. date? Yes - 2013
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 up to 3 children being newborn and up
Do you need to bring your children to work with you and if so, please list your children's age? Yes for 3 hours/day
For elder care or companion care candidates, please briefly describe what you are looking for. N/A

DESIRED EMPLOYMENT
List the type: Nanny, babysitter or nanny/housekeeper for full-time, live-out and long-term employment
Nanny, babysitter, full-time, live-out

EMPLOYMENT AVAILABILITY/RELOCATION INFO
Are you available for work Monday thru Friday or other days? Yes - Monday thru Friday (Weekends off)
List the available hours: From 7:00 AM to 5:00 PM
List locations you are willing to consider for work: Annandale, Arlington & Alexandria in Virginia
Can you work overtime, if needed? Perhaps, will discuss this with employer but will need extra pay for overtime work
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? N/A
If hired, when can you start work? Looking for immediate hire or ASAP

DESIRED SALARY & EMPLOYEE BENEFITS
List salary expectations for a weekly or daily work schedule: $10/hour or $400/week (Need to discuss tax issues prior to starting employment)
List desired benefit package (if offered): Prefer to have federal holidays off with pay, have one week vacation paid
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 another country other than the U.S., list nation: Indonesia
Did you graduate from college and if so, list the year you graduated and your major:Yes, a B.A. in business mgm't, graduated in 1998
Are you currently a student and if so, please list your area of study, the days and hours of your classes:No
Please list a person's contact name and phone number in case of an emergency: Withholding information for now
Have you ever been convicted of a felony? No

WORK REFERENCE FORM

LIST WORK REFERENCES
(1) LIST THE NAME OF YOUR EMPLOYER:
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION: Virginia
LIST DATES WORKED: From 06/07 to 01/10
LIST YOUR JOB TITLE: Babysitter
LIST JOB DUTIES: Child-related duties
LIST CHILDREN'S AGES: Started caring for child at 6 months through pre-school age
WHY DID YOU LEAVE THIS JOB? Job ended - Child started pre-school
EMPLOYER COMMENTS: REFERENCES ARE PENDING

(2) LIST THE NAME OF YOUR EMPLOYER:
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION:
LIST DATES WORKED:
LIST YOUR JOB TITLE:
LIST JOB DUTIES:
LIST CHILDREN'S AGES:
WHY DID YOU LEAVE THIS JOB?
EMPLOYER COMMENTS:



If you would like to meet with Linda A. 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

FAMILIES HELP LINE
Office Telephone: 301-868-4420 (It is best to call between 9:00 a.m. and 5:00 p.m., EST, Monday through Friday.)
Send us an e-mail! (It is best to contact us after work hours and on weekends by e-mail.)


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