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EMPLOYMENT APPLICATION FORM

PERSONAL INFORMATION
NAME: RINOU T.
Address: Germantown, State MD, Zip Code 20874
Home Phone: Withholding for now
Cell Phone: Withholding for now

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, a U.S. Citizen
Do you have at least two years of recent experience as a nanny or domestic worker? Yes
Do you speak English? Yes
Do you have work references? Yes, excellent
Do you drive? YES, State: Maryland
List driving violations and dates if applicable: None (Must be updated on this question)
Do you wish to drive child/ren or adult in your vehicle while they are in your care? YES
If yes, do you have adequate vehicle insurance? Yes
Do you prefer your employer provide you with a vehicle for job-related duties? Yes, but I do not mind using my own vehicle, provided I am reimbursed for any gas mileage used while transporting child.
Are you CPR certified for infants/children or adults? Not certified
Are you a smoker or a non-smoker? Non-Smoker
How many children will you care for? One infant or child up to 8 years of age - May consider two children if one of them is under 5 years of age
Do you need to bring your child to work with? No (Her children are all grown/adults)
Do you speak a fluent language other than English and if so, please list the language? Yes, Fluent in Hindi, Persian, French, German

DESIRED EMPLOYMENT
Are you looking for part-time, full-time, live-in, live-out employment? Part-time, live-out, long-term nanny employment (No housekeeping/laundry or cooking other than for the children's needs)

EMPLOYMENT AVAILABILITY/RELOCATION INFO
Are you available for work Monday thru Friday? Yes
List the available hours: Up to 25 hours/week between 9AM (maybe 8:00 AM) up to 7:00 PM weekdays (Days/hours are somewhat flexible)
List locations you are willing to consider for work: In or close to Germantown, Damascus, Gaithersburg, Rockville, Potomac in Maryland
Can you work overtime, if needed? Yes, occasionally but will require extra pay
Do you want to relocate for work in the U.S.? No
Are you willing to pay travel, lodging & food expenses as part of your relocating costs? No
If hired, when can you start work? ASAP

DESIRED SALARY & EMPLOYEE BENEFITS
List salary expectations: $15/hour for one infant or child (possibly two children if only one child is under 5 years of age) and lives within close range to Germantown - Rate includes only those duties pertaining to the children's requirements - Can work up to 25 hours/week but will need a minimum of 17.5 to 20 hours/week for part-time help
List desired benefits preferred: If offered, 2 weeks paid vacation, 1 week paid sick leave, paid federal holidays

EDUCATIONAL BACKGROUND INFORMATION
Did you graduate from high school? Yes If so, list location of the educational institution you graduated from? Kabul Afghanistan
Did you graduate from college? Yes\
If so, list type of degree and location of the educational institution you graduated from? Bachelor of Arts in French Literature, University of Kabul, Afghanistan
Please list a person's contact name and telephone number in case of an emergency: Withholding for now Phone: Withholding for now
Have you ever been convicted of a felony? No

EMPLOYMENT REFERENCES

WORK REFERENCES

LIST JOB APPLICANT NAME: Rinou T.

#1. List the Employer Name: SINDHU R. Tel # Withholding for now (Home) Call after 6 p.m. weekdays
List Location: MARYLAND Dates worked/MARCH OF 2006 thru JAN. OF 2009
List Title: Nanny - Full-time _ Part-time X Live-in _ Live-out X
List Duties: Cared for one child, age when she first started position was 6 years - Performed only child care-related duties
Reason for Leaving? Position ended - Rinou still stays in touch with this family on a friendly basis.
Reference Check Review - Talked to Sindhu R. on Feb. 11, 2006 (Contact at anytime but best to reach her after 6:00 p.m.) weekdays.
Employment Recommendation: Poor __ Fair __ Very Good _ Excellent X
Confirmed Employment Dates & Termination __
Would Not Cooperate __
References Pending __
Employer Comments: Sindhu R. gave Rinou an excellent recommendation caring for her child.

#2. List the Employer Name: LAURA T. Tel # Withholding for now
List Location: MARYLAND Dates worked/OCT. 2005 thru FEB 10. 2006
List Title: Nanny - Full-time _ Part-time X Live-in _ Live-out X
List Duties: Cared for one child, age 2 years - performed childcare-related duties
Reason for Leaving? The position will end due to her employer making a residential move.
Currently, Rinou is still employed but can end the position within one to two weeks' notice.
Reference Check Review - Talked to LAURA T. on February 16, 2006
Employment Recommendation: Poor __ Fair __ Very Good _ Excellent X
Confirmed Employment Dates & Termination X Would Not Cooperate __
References Pending _
Employer Comments: Ms T. highly recommends Rinou working with her child. She said Rinou interacted with the child very well and the child loved being with her.

#3. List the Employer Name: BETH P. Tel # Withholding for now
List Location: Dates worked/ MARCH 2000 thru MARCH 2005
List Title: Nanny F/T X or P/T _ Live-in _ Live-out X
List Duties: Child care duties for two children age, newborn and 16 months
Reason for Leaving? Position ended, family moved to Switzerland
Reference Check Review - Families Help Line did not contact Beth P. since her location is outside of the U.S. The prospective employer may feel free to contact the individual at her current telephone number shown above in Geneva, Switzerland

#4. List the Employer Name: LAUREN J. Tel # Withholding for now
List Location: PRINCETON, NJ Dates worked/ 1997 thru 2000
List Title: Nanny - Full-time position at first, then was cut back to four days/week Live-in _ Live-out X
List Duties: Cared for two children, age 4 years and a newborn - performed childcare-related duties
Reason for Leaving? Rinou moved to Maryland - Rinou continues to stay in touch with the family on very friendly terms.
Reference Check Review - Talked to LAUREN J. On September 3, 2005
Employment Recommendation: Poor __ Fair __ Very Good _ Excellent X
Confirmed Employment Dates & Termination X Would Not Cooperate __
References Pending _
Employer Comments: Lauren J. highly recommends Rinou in a position that requires childcare. Rinou was great when interacting with her children. She met Rinouís family and they were lovely. She also commented on if an employer is given the opportunity to hire Rinou, he/she should do it!


If you would like to meet with Rinou T. 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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