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EMPLOYMENT APPLICATION
PERSONAL INFORMATION
List Job Applicant's Name: REINA P.
List Home Address: Silver Spring, Maryland 20901
List Home Phone #: Withholding for now
List E-mail Address: N/A
GENERAL INFORMATION
Are you 18 years or older? Yes (Early 60s)
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 - 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 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? 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: None upon registering with service
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 up to 3 children 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, her children are grown adults
For elder care or companion care candidates, please briefly describe what you are looking for. Care for an elder or couple who need help with housecleaning, laundry, grocery shopping/running errands, non medical caregiving assistance or companionship
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 long-term or a Summer position
Housekeeper, Cook, Laundress, Mother’s helper for child care and household help, driving children/adults, Companion or Elder Care, 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: Part-time includes Monday from 8:00 a.m. to 10:00 a.m., Tuesday from 8:00 a.m. to 11:30 a.m./12:00 p.m., Wednesday from 8:00 a.m. to 11:30/12:00 p.m., Thursday from 8:00 a.m. to 11:30/12:00 p.m., Friday from 8:00 a.m. to 11:30/12:00 p.m. and/or Monday through Friday from 3:00/7:00 or 8:00 p.m. Will need a 20-hour minimum for part-time help or will work less hours (12 to 15 hour-week minimum) at a higher rate.
List locations you are willing to consider for work: Maryland areas including Bethesda, Chevy Chase, Gaithersburg, Kensington, Brookville, Olney, Rockville, Silver Spring, Wheaton, Takoma Park, College Park 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 hourly work schedule: $17.50/hour at a minimum of 20 hours/week or $20/hour for a minimum of 12 to 15 hours/week -Prefer employer is open to paying his or her applicable employer-employee related FICA tax - Will need extra pay at 50 cent/mile on top of regular salary if driving her vehicle is a requirement.
List duties you will perform: General housecleaning, laundry, cooking, grocery shopping/ running errands, driving children to/from school or activities, companion or elder care for an adult or couple
List desired benefit's package: If offered, paid federal holidays, 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: El Salvador
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: REINA P.
LIST WORK REFERENCES (List most recent employer first)
(1) LIST THE NAME OF YOUR EMPLOYER: LINDA F.
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION (list city/state only): BETHESDA, MD
LIST DATES WORKED: 1986 - JULY 2011 (CURRENT - PART-TIME)
LIST YOUR JOB TITLE: HOUSEKEEPER/LAUNDRESS/ASSISTANT TO ELDER GENTLEMAN
LIST JOB DUTIES: Housecleaning, laundry, some child care assistance on as needed basis and elder care assistance for a gentleman, and tending to his needs on as needed basis.
LIST CHILDREN'S AGES: N/A
WHY DID YOU LEAVE THIS JOB? This job is current - 1-day week on Tuesday - Reina will continue staying on with this employer.
EMPLOYER'S COMMENTS: Talked to Linda F. on 7-13-11 - She highly recommends Reina as a housekeeper, laundress, child care assistance and elder care on as needed basis. Anyone may feel free to contact her in reference to her employ of Reina.
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(2) LIST THE NAME OF YOUR EMPLOYER: JANICE G.
LIST EMPLOYER'S PHONE NUMBER: Withholding for now
LIST JOB LOCATION (list city/state only): WASHINGTON, DC
LIST DATES WORKED: 1993 - 1995
LIST YOUR JOB TITLE: HOUSEKEEPER
LIST JOB DUTIES: General housecleaning and laundry
LIST CHILDREN'S AGES: N/A
WHY DID YOU LEAVE THIS JOB? Family needed to hire a nanny and couldn’t afford to pay for a separate housekeeper any longer.
EMPLOYER'S COMMENTS: Talked to Janice G. 11-16-01 - She highly recommends Reina as housekeeper/laundress.
If you would like to meet with Reina P.. 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.)
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