Candidate Application Form
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?
Have you ever been arrested or convicted of a crime?
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 *
Required
Job Description: *
Select all that apply
Required
Job Type
Please select 1
List Work Schedule Days/Hours
Select all the apply:
Hours
(ie, 9am - 5pm)
Your answer
Is your schedule open and flexible?
Do you speak English?
Do you speak Spanish?
Do you smoke?
What is your salary requirement per hour for a new job?
Your answer
Do you drive?
Do you own a car?
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?
Would you be willing to use the employer's vehicle?
Do you have any driving tickets in the last 3 year?
If yes, please explain...
Your answer
Do you receive text messages on your phone?
What did you do in your country?
Your answer
Do you swim?
Will you clean the family's clothes?
Do you iron?
Would you be willing to cook for parents?
Would you be willing to cook for kids?
Do you observe dietary laws?
If yes, which dietary laws?
Your answer
Do you like animals?
Are you allergic to animals?
Will you take care of the kids at night?
Are you willing to clean bathrooms?
Are you willing to clean up after the children?
Are you willing to wear a unifom?
Do you have newborn experience?
Will you follow a schedule?
Did you take courses in newborn care?
Experience with twins?
Experience with triplets?
If you are a live in candidate, will you share a bathroom with a child?
Are you CPR certified?
If certified, when does it expire?
Your answer
If not certified, would you be willing to take CPR classes?
Are you willing to change diapers?
Are you willing to travel with the family?
Are you willing to travel with the family - by car?
Are you willing to travel with the family - by plane?
Did you attend college?
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
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
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
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.
M
C
A
Your answer
K
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service