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EMPLOYMENT APPLICATION

PERSONAL INFORMATION

Print Job Applicant’s Name: MARTA D.
Address DUMFRIES, VIRGINIA
Home Phone withholding for now
Fax # withholding for now
Cell Phone withholding for now
E-mail address withholding for now

GENERAL INFORMATION

Are you 18 years or older? Yes X No__ (43 years)
If employed, could you submit proof of your legal right to work in U.S. to your employer?
Yes X No_ (A Permanent Resident Card and Social Security ID Card/Number copy on file in 2002)
Do you have at least two years of recent experience as a nanny or domestic worker? Yes X No__
Do you speak English? Yes X No __/If no, list language:
Do you have work references? Yes X No_ (See below for work references.)
Do you drive? Yes X No __ /State VA /Driver Lic. Withholding info until hired
List driving violations: None upon taking her application in 2002
Do you wish to drive children or an adult in your vehicle while they are in your care?
Yes X No __ (Will need extra compensation if using her own vehicle for gas milage--tbd at interview)
If yes, do you have adequate vehicle insurance? Yes X No__
Do you prefer your employer provides you with a vehicle for job-related duties? Yes X No__ Either way is fine
Are you CPR certified for infants/children___or adults__? Yes _ No X but open to getting certified if the family wants to pay for the class
Are you a smoker__ or a non smoker X? (Check one)
Please list desired number of children you will provide care and their ages. 1 up to 3 children, Newborn up to teen years
Do you need to bring your child to work with you? Yes __ No X
Are you fine working with pets? Yes X No __ (Dogs/cats are fine)
Do you speak a fluent language other than English? Yes X No__/List language: Spanish - Will share Spanish with child/ren
What age group of children do you prefer to work with? Any age is fine - Infant up to teen years

DESIRED EMPLOYMENT

Which applies to you?
Part-time, Live-out
What position applies to you? Nanny, Housekeeper, Nanny/Houskeeper, Housekeeper/nanny or Day Worker at 4-hours/day on a weekly basis or an 8-hour day on Saturday on a weekly basis

EMPLOYMENT AVAILABILITY/RELOCATION INFO

Check days available for work: Mon. X Tues. X Wed. X Thurs. X Fri. X Sat.X Sun. X
List hours available: Late afternoon/evening hours, Monday through Friday from 4:00 p.m. up to 10:00 p.m. and flexible hours on Saturday and maybe Sunday as well
List locations you are willing to consider for work: Northern Virginia area including Alexandria, Arlington, Burke, Centreville, Chantilly, Dumfries, Fairfax, Falls Church, Lorton, McLean, Springfield, Sterling, Tysons and Vienna
Can you work overtime, if needed? Yes X No__/Comments: On occasion with extra pay/will discuss w/employer
Do you want to relocate for work in the U. S.? Yes_ No X
If applicable, are you willing to pay travel, lodging & food expenses as part of relocating costs?
Yes__ No__/N/A X
If hired, when can you start work? Prefers to work asap - Will only consider immediate job offers

DESIRED SALARY & EMPLOYEE BENEFITS

List salary expectations: Housekeeper, Nanny, Nanny/housekeeper at $15/hour - Includes housecleaning and laundry duties or care of one up to three children with light housecleaning, children's laundry, cooking their meals and running errands - Will need a minimum of 20 hours/week for part-time help - Day Worker rate is $17/hour at a 4-hour/day on a weekly work schedule - Includes housecleaning and laundry
List desired employee benefits: Preferred paid federal holidays/vacation pay and anything else offered

EDUCATIONAL BACKGROUND INFORMATION

Did you graduate from high school in the U.S.? Yes _ No X - If you went to school outside of the U.S., check here X and list your native country here: El Salvador
Did you graduate from college? Yes__ No X If other than U.S., check here__
Have you ever been convicted of a felony? Yes __ No X



JOB APPLICANT EMPLOYMENT WORK REFERENCES

Most recent jobs are listed first.

Job Applicant’s Name: MARTA D.

#1. List Name of Employer: Former U.S. Senator (Name being withheld for now)
City/State: WASH. DC
Dates worked/SEPT. 2001 To May 2009
Employed as HOUSEKEEPER
Full-time X Part-time X (Current) Live-in _ Live-out X
Check duties: Child Care__ Driving__ Housecleaning X Some Cooking X Personal Care X (Marta had also provided personal care for this
individual while he recovered from major surgery during a portion of her employment.) Laundry X Ran Errands X
How many children did you care for? N/A /List their ages:
Why did you leave this job? Position ended - No longer needed help

Reference Check Review - Talked to Senator's secretary on MARCH 12, 2004
Employment Recommendation was Poor__ Fair__ Excellent X
Confirmed Employment Dates and/or Termination X
Would Not cooperate__
Others May Contact Current or Past Employer Yes X No__
See Attached Letter of Recommendation X
References Pending _

Letter of Recommendation for Marta D.
Fom: Former U.S. Senator
Dated: May 5, 2009

TO WHOM IT MAY CONCERN

I had the pleasure of working with Marta D. from 2001 through 2009. As my housekeeper, I came to know Marta and her family on a personal and professional basis. Marta is a trustworthy and hardworking individual who strives for excellence in all that she does.

On a personal level, Marta is a caring and a responsible person, and I feel comfortable in saying that she is capable in handling any situation that may arise.

It is a pleasure to know and have worked with Marta for nearly 8 years and I would recommend her for any future endeavor. If you need more information give me a call at...

Sincerely,

Former U.S. Senator (Name being withheld for now)

#2. List Name of Employer: Kathleen. W.
City/State NORTHERN VA Dates worked/ MARCH 2002 To JUNE 2004
Employed as NANNY/HOUSEKEEPER/Full-time Part-time X Live-in Live-out X
Check duties: Child Care X (children were under 5 years) Driving __ Housecleaning X Cooking __ Laundry X
List other duties if not listed:
How many children did you care for? Assisted mom in care of 3 children - 2.5 years, 15 months and later on another newborn
Why did you leave this job? Work hours were greatly reduced - Marta needed more hours/income

Reference Check Review - Talked to Kathleen. W. on MARCH 3, 2004
Employment Recommendation was Poor __ Fair__ Good __Excellent X
Confirmed Employment Dates & Termination X
Would Not cooperate__
Others May Contact Current or Past Employer Yes X No__
See Attached Letter of Recommendation__
References Pending__

#3. List Name of Employer: Janna. G.
City/State: NORTHERN VA
Dates worked/ JAN. 1998 To JAN. 2005
Employed as a /Full-time__ Part-time X Live-in__ Live-out X
Check duties: Child Care X Driving X Housecleaning X Laundry X
List other duties if not listed:
How many children did you care for? 3 /List their ages: infant then later on two more infants
Why did you leave this job? Family no longer needed help - Marta stays in in touch with this family on very friendly terms and helps still helps out on as needed basis.

Reference Check Review - Talked to J. G. on MARCH 5, 2002
Employment Recommendation was Poor __ Fair__ Very Good __ Excellent X
Confirmed Employment Dates & Termination X Would Not cooperate __
Others May Contact Current or Past Employer Yes X No__
See Attached Letter of Recommendation__
References Pending__


If you would like to meet with Marta D. 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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