Candidate Application Form
* Required
Full Name:
Your answer
Street Address:
Your answer
City:
Your answer
State:
Your answer
Zip:
*
Your answer
Email:
Your answer
Cell Phone:
*
Your answer
Social Security Number:
Your answer
Are you legal to work in the United States?
Yes
No
Have you ever been arrested or convicted of a crime?
Yes
No
Driver's License Number:
Your answer
Country of Birth:
Your answer
Date of Birth:
MM
/
DD
/
YYYY
Emergency Contact Number
Your answer
Relationship to Emergency Contact
Your answer
Area of Miami you reside
*
Kendall
Near Airport
Coral Gables
Coconut Grove
Little Havana
Miami Beach
Aventura
Downtown
Other:
Required
Job Description:
*
Select all that apply
Live-In
Live-Out
Part-Time
Temporary/As-Needed Baby Sitter
Other:
Required
Job Type
Please select 1
Nanny/Housekeeper
Nanny only
Housekeeper only
Elderly Companion
Baby Specialist (overnight or 24hour care)
Other:
List Work Schedule Days/Hours
Select all the apply:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Hours
(ie, 9am - 5pm)
Your answer
Is your schedule open and flexible?
Yes
No
Do you speak English?
Yes
No
Do you speak Spanish?
Yes
No
Do you smoke?
Yes
No
What is your salary requirement per hour for a new job?
Your answer
Do you drive?
Yes
No
Do you own a car?
Yes
No
Model/Make of your car:
i.e., Mazda
Your answer
Year of your car:
i.e., 2014
Your answer
Would you be willing to transport the children in your vehicle?
Yes
No
Would you be willing to use the employer's vehicle?
Yes
No
Do you have any driving tickets in the last 3 year?
Yes
No
If yes, please explain...
Your answer
Do you receive text messages on your phone?
Yes
No
What did you do in your country?
Your answer
Do you swim?
Yes
No
Will you clean the family's clothes?
Yes
No
Do you iron?
Yes
No
Would you be willing to cook for parents?
Yes
No
Would you be willing to cook for kids?
Yes
No
Do you observe dietary laws?
Yes
No
If yes, which dietary laws?
Your answer
Do you like animals?
Yes
No
Are you allergic to animals?
Yes
No
Will you take care of the kids at night?
Yes
No
Are you willing to clean bathrooms?
Yes
No
Are you willing to clean up after the children?
Yes
No
Are you willing to wear a unifom?
Yes
No
Do you have newborn experience?
Yes
No
Will you follow a schedule?
Yes
No
Did you take courses in newborn care?
Yes
No
Experience with twins?
Yes
No
Experience with triplets?
Yes
No
If you are a live in candidate, will you share a bathroom with a child?
Yes
No
Are you CPR certified?
Yes
No
If certified, when does it expire?
Your answer
If not certified, would you be willing to take CPR classes?
Yes
No
Are you willing to change diapers?
Yes
No
Are you willing to travel with the family?
Yes
No
Are you willing to travel with the family - by car?
Yes
No
Are you willing to travel with the family - by plane?
Yes
No
Did you attend college?
Yes
No
If yes, how many years did you attend?
Your answer
If yes, what specialty courses?
Your answer
Reference 1: Name of Employer
Your answer
Reference 1: Phone Number of Employer
Your answer
Reference 1: What month and year did you start?
i.e., 12/2010
Your answer
Reference 1: What month and year did you end?
i.e., 5/2012
Your answer
Reference 1: How old were the children when you started the job?
i.e, 6 month old and 3 year old
Your answer
Reference 1: What did you do for the family?
Check all that apply
Cleaned the house
Took care of the children
Washed clothes
Ironed
Ran errands
Drove to activities
Cooked for the adults
Cooked for the children
Traveled with the family
Other:
Reference 1: Reason for leaving the job?
Your answer
Reference 1: What was your salary per hour when you started the job?
i.e., $12 per hour
Your answer
Reference 2: Name of Employer
Your answer
Reference 2: Phone Number of Employer
Your answer
Reference 2: What month and year did you start?
i.e., 2/2011
Your answer
Reference 2: What month and year did you end?
i.e., 6/2013
Your answer
Reference 2: How old were the children when you started the job?
i.e, 6 month old and 3 year old
Your answer
Reference 2: What did you do for the family?
Check all that apply
Cleaned the house
Took care of the children
Washed clothes
Ironed
Ran errands
Drove to activities
Cooked for the adults
Cooked for the children
Traveled with the family
Other:
Reference 2: Reason for leaving the job?
Your answer
Reference 2: What was your salary per hour when you started the job?
i.e., $10 per hour
Your answer
Reference 3: Name of Emplyoer
Your answer
Reference 3: Phone Number of Emplyoer
Your answer
Reference 3: What month and year did you start?
i.e., 2/2011
Your answer
Reference 3: What month and year did you end?
i.e., 6/2013
Your answer
Reference 3: How old were the children when you started the job?
i.e, 8 month old and 2 year old
Your answer
Reference 3: What did you do for the family?
Check all that apply
Cleaned the house
Took care of the children
Washed clothes
Ironed
Ran errands
Drove to activities
Cooked for the adults
Cooked for the children
Traveled with the family
Other:
Reference 3: Reason for leaving the job?
Your answer
Reference 3: What was your salary per hour when you started the job?
i.e., $11 per hour
Your answer
When can you start working a new job for a family?
Your answer
How did you hear about Class Act Nannies, LLC?
Your answer
*******Hit Submit Now - The last questions are for office use only.
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