Candidate Application Form
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Full Name:
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Street Address:
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City:
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State:
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Zip:
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Email:
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Cell Phone:
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Social Security Number:
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Are you legal to work in the United States?
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Have you ever been arrested or convicted of a crime?
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No
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Driver's License Number:
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Country of Birth:
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Date of Birth:
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DD
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YYYY
Emergency Contact Number
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Relationship to Emergency Contact
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Area of Miami you reside
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Kendall
Near Airport
Coral Gables
Coconut Grove
Little Havana
Miami Beach
Aventura
Downtown
Other:
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Job Description:
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Select all that apply
Live-In
Live-Out
Part-Time
Temporary/As-Needed Baby Sitter
Other:
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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)
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Is your schedule open and flexible?
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No
Do you speak English?
Yes
No
Do you speak Spanish?
Yes
No
Do you smoke?
Yes
No
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What is your salary requirement per hour for a new job?
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Do you drive?
Yes
No
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Do you own a car?
Yes
No
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Model/Make of your car:
i.e., Mazda
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Year of your car:
i.e., 2014
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Would you be willing to transport the children in your vehicle?
Yes
No
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Would you be willing to use the employer's vehicle?
Yes
No
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Do you have any driving tickets in the last 3 year?
Yes
No
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If yes, please explain...
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Do you receive text messages on your phone?
Yes
No
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What did you do in your country?
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Do you swim?
Yes
No
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Will you clean the family's clothes?
Yes
No
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Do you iron?
Yes
No
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Would you be willing to cook for parents?
Yes
No
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Would you be willing to cook for kids?
Yes
No
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Do you observe dietary laws?
Yes
No
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If yes, which dietary laws?
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Do you like animals?
Yes
No
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Are you allergic to animals?
Yes
No
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Will you take care of the kids at night?
Yes
No
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Are you willing to clean bathrooms?
Yes
No
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Are you willing to clean up after the children?
Yes
No
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Are you willing to wear a unifom?
Yes
No
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Do you have newborn experience?
Yes
No
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Will you follow a schedule?
Yes
No
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Did you take courses in newborn care?
Yes
No
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Experience with twins?
Yes
No
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Experience with triplets?
Yes
No
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If you are a live in candidate, will you share a bathroom with a child?
Yes
No
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Are you CPR certified?
Yes
No
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If certified, when does it expire?
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If not certified, would you be willing to take CPR classes?
Yes
No
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Are you willing to change diapers?
Yes
No
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Are you willing to travel with the family?
Yes
No
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Are you willing to travel with the family - by car?
Yes
No
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Are you willing to travel with the family - by plane?
Yes
No
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Did you attend college?
Yes
No
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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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A
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