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EMPLOYMENT APPLICATION

PERSONAL INFORMATION
List Job Applicant's Name: SEZ F.
List Home Address: Silver Spring, MD 20904
List Home 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 (Exp. a Resident Card, Work Permit or Student Visa)? 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 language(s)? Yes, French
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:
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
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 babysitter for full-time, live-out or live-in, part-time, live-out or live-in, long-term or permanent employment

EMPLOYMENT AVAILABILITY/RELOCATION INFO
If hired, when can you start work? Prefer in Jan. around the 16th (1/16/11)
List the days/hours you are available for work: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday with flexible hours being at 8 or 9 hour days (Maybe longer hours if needed)
List locations you are willing to consider for work: Maryland areas including in or near Silver Spring, Bethesda, Chevy Chase, Rockville, Potomac and NW-DC
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 an hourly work schedule and duties you will perform:
Nanny or babysitter rate is $15 up to $20/hour - Will need a 20-hour/week minimum for part-time work - Duties include caring/supervising for one or two children, driving them to/from school/activities, if time allows, helping out with light housecleaning, laundry and cooking pertaining to the children's requiremetns
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: Free room and board (all meals being provided by employer), a private bedroom and bath or share bath with children, access to tv and Internet would be a plus

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: Senegal, W. Africa
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 had any past criminal record? No

WORK REFERENCES

Applicant Name: SEZ F.

LIST WORK REFERENCES (List most recent employer first)

(1) LIST THE NAME OF YOUR EMPLOYER: PRIVATE HOUSEHOLD
LIST EMPLOYER'S PHONE NUMBER: WITHHOLDING FOR NOW
LIST JOB LOCATION (list city/state only): SILVER SPRING, MD
LIST DATES WORKED: JUNE 2008 - DEC. 2010 (CURRENT FULL-TIME UP UNTIL JAN. 16, 2011)
LIST YOUR JOB TITLE: NANNY
LIST JOB DUTIES: Cared for one newborn and helped out with duties pertaining to the child's requirements
LIST CHILDREN'S AGES: Infant - Current age is 19 months
WHY DID YOU LEAVE THIS JOB? Her employer is pregnant and plans on quitting her job and staying home with her child
EMPLOYER'S COMMENTS: 12-17-10 - Highly recommends Sez caring for children - She is honest, reliable, well-mannered, loving and a very caring person. Others may contact her regarding her employ of Sez.

(2) LIST THE NAME OF YOUR EMPLOYER: PRIVATE HOUSEHOLD
LIST EMPLOYER'S PHONE NUMBER: WITHHOLDING FOR NOW
LIST JOB LOCATION (list city/state only): BETHESDA, MD
LIST DATES WORKED: 2003 - SEPT. 2008
LIST YOUR JOB TITLE: NANNY
LIST JOB DUTIES: Cared for two children, driving them to/from school/activities and helped with all duties pertaining to their requirements
LIST CHILDREN'S AGES: Infant and 18 months
WHY DID YOU LEAVE THIS JOB? Job ended by children starting school
EMPLOYER'S COMMENTS: Pending

(3) LIST THE NAME OF YOUR EMPLOYER: PRIVATE HOUSEHOLD
LIST EMPLOYER'S PHONE NUMBER: WITHHOLDING FOR NOW
LIST JOB LOCATION (list city/state only): BETHESDA, MD
LIST DATES WORKED: 1998 - NOV. 2003
LIST YOUR JOB TITLE: NANNY
LIST JOB DUTIES: Child care related duties
LIST CHILDREN'S AGES: New born up to 5 years
WHY DID YOU LEAVE THIS JOB? Child started school
EMPLOYER'S COMMENTS: Pending

(4) LIST THE NAME OF YOUR EMPLOYER: PRIVATE HOUSEHOLD
LIST EMPLOYER'S PHONE NUMBER: WITHHOLDING FOR NOW
LIST JOB LOCATION (list city/state only): ROCKVILLE, MD
LIST DATES WORKED: 1995 - 1998
LIST YOUR JOB TITLE: NANNY
LIST JOB DUTIES: Child care related duties for three children
LIST CHILDREN'S AGES: 4, 6 & 9 years
WHY DID YOU LEAVE THIS JOB? Family lost their income and couldn't afford to pay a nanny
EMPLOYER'S COMMENTS: Pending

(5) LIST THE NAME OF YOUR EMPLOYER: PRIVATE HOUSEHOLD
LIST EMPLOYER'S PHONE NUMBER: WITHHOLDING FOR NOW
LIST JOB LOCATION (list city/state only): SILVER SPRING, MD
LIST DATES WORKED: 1992 - 1995
LIST YOUR JOB TITLE: NANNY
LIST JOB DUTIES: Child care related duties for two children
LIST CHILDREN'S AGES: New born and a 5 year old
WHY DID YOU LEAVE THIS JOB? Younger child started school and family no longer needed a nanny
EMPLOYER'S COMMENTS: Pending

If you would like to meet with Sez F. 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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