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EMPLOYMENT APPLICATION

PERSONAL INFORMATION
List Job Applicant's Name: MARTHA O.
List Home Address: Silver Spring, Maryland 20902
List Home Phone #: Withholding for now
List E-mail Address: N/A

GENERAL INFORMATION
Are you 18 years or older? Yes - 43 years
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)? Spanish
Do you have a driver's license and do you have your own vehicle? No to both questions
If applicable, list the state you have your driver's license and the expiration date: N/A
List driving violations and dates if applicable: None over the last 8 years
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 - Infants 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 children (maybe 3), 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 - Has child care provisions in place
For elder care or companion care candidates, please briefly describe what you are looking for. N/A

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 longterm or a Summer position

Nanny or Nanny/housekeeper for 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: Available for THREE full days being Monday, Wednesday, Thursday or Friday from 8:00 a.m. through 5:00 p.m. (or if needed up to 6:00/6:30 p.m.)
List locations you are willing to consider for work: Maryland areas to include Bethesda, Brookville, Chevy Chase, Kensington, Rockville, Olney, Silver Spring, Wheaton and NW - DC
Can you work overtime, if needed? Maybe on occasion - 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? N/A

DESIRED SALARY & EMPLOYEE BENEFITS
List salary expectations for an hourly work schedule and duties you will perform:
Part-time nanny or nanny/housekeeper rate starts at $15/hour up to $18/hour, depending upon number of children needing care and duties - Duties include caring/supervising for one up to three children, walking them to/from school/activities, library/park, and if time allows, helping out with light housecleaning, laundry and cooking children's meals
List desired benefit's package: Paid federal holidays, one or 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: Nicaragua
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: MARTHA O.

LIST WORK REFERENCES (List most recent employer first)

(1) LIST THE NAME OF YOUR EMPLOYER: DR. NICOLE C.
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION (list city/state only): BETHESDA, MD
LIST DATES WORKED: MARCH 2011 - MAY 2011 (CURRENT) (PART-TIME, 1 DAY/WEEK ON TUESDAYS)
LIST YOUR JOB TITLE: NANNY
LIST JOB DUTIES: Currently cares for one infant and all duties pertaining to the child's requirements.
LIST CHILDREN'S AGES: 1-year old
WHY DID YOU LEAVE THIS JOB? This job is current and Martha will continue working with this family
EMPLOYER'S COMMENTS: Pending

(2) LIST THE NAME OF YOUR EMPLOYER: RINALDO S.
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION (list city/state only): GERMANTOWN, MD
LIST DATES WORKED: DEC. 2007 - DEC. 2010 (PART-TIME, CHILD CARE)
LIST YOUR JOB TITLE: NANNY
LIST JOB DUTIES: Cared for one infant and helped out with all duties pertaining to the child's requirements.
LIST CHILDREN'S AGES: 3 months
WHY DID YOU LEAVE THIS JOB? Job ended and no longer needed help
EMPLOYER'S COMMENTS: Pending

(3) LIST THE NAME OF YOUR EMPLOYER: MRS. C.
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION (list city/state only): SILVER SPRING, MD
LIST DATES WORKED: NOV. 2009 - JUNE 2010
LIST YOUR JOB TITLE: DAY CARE PROVIDER (In Martha's home)
LIST JOB DUTIES: Cared for two children and helped out with all duties pertaining to their requirements
LIST CHILDREN'S AGES: 9 months and 2 years
WHY DID YOU LEAVE THIS JOB? Family moved out of area
EMPLOYER'S COMMENTS: This employer left no forwarding address or phone number

(4) LIST THE NAME OF YOUR EMPLOYER: KIM M.
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION (list city/state only): GERMANTOWN, MD
LIST DATES WORKED: JAN. 2005 - APRIL 2005 (PART-TIME CHILD CARE)
LIST YOUR JOB TITLE: NANNY
LIST JOB DUTIES: Cared for one baby and helped out with all duties pertaining to the child' requirements
LIST CHILDREN'S AGES: 9 months and 2 years
WHY DID YOU LEAVE THIS JOB? Family moved out of area
EMPLOYER'S COMMENTS: Kim M. gave Martha an excellent work recommendation, commenting on how her son loved being with Martha. He would have a big smile on his face every time she would come to their home - That alone says a lot. Martha kept her child active by playing with him, reading to him, and teaching him Spanish. If needed, this employer is available for further comment by phone in Georgia.

(5) LIST THE NAME OF YOUR EMPLOYER: DR. KATHRYN C.
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION (list city/state only): WHEATON, MD
LIST DATES WORKED: JULY 2005 - FEB. 2007
LIST YOUR JOB TITLE: NANNY/HOUSEKEEPER
LIST JOB DUTIES: Cared for one infant and helped out with all duties pertaining to the child's requirements and helped out with some light housecleaning
LIST CHILDREN'S AGES: 6 weeks through 22 months
WHY DID YOU LEAVE THIS JOB? Family placed child in Montessori school
EMPLOYER'S COMMENTS: Dr. C. highly recommends Martha in caring for her infant - She always kept her child clean, safe and well cared for. She appreciated her keeping the child active with indoor/outdoor play, outings to nearby library and taking her to the playground, always keeping her daughter's safety in mind. Martha's best quality is loving children. She had certainly contributed to her daughter's development into a self-assured, happy child who is now ready for a group school setting. She has helped around the home, above the call of her nanny duties on her own initiative. She was very good about hygiene (hand washing) when tending to the child, and followed a daily routine directed by the parent. If needed for further comment, any one may feel free to contact this employer regarding her employ of Martha.

(6) LIST THE NAME OF YOUR EMPLOYER: Grace G.
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION (list city/state only): KENSINGTON, MD
LIST DATES WORKED: 1994 - 1999
LIST YOUR JOB TITLE: NANNY/HOUSEKEEPER
LIST JOB DUTIES: Cared for three children and helped out with all their requirements, plus assisted with light housecleaning
LIST CHILDREN'S AGES: Newborn, 1 1/2 and 5 years
WHY DID YOU LEAVE THIS JOB? Family no longer needed help
EMPLOYER'S COMMENTS: Grace G. gave Martha an excellent recommendation in caring for her children.


If you would like to meet with Martha O. 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!

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