Candidate Application Form
Full Name:
Street Address:
City:
State:
Zip: *
Email:
Cell Phone: *
Social Security Number:
Are you legal to work in the United States?
Clear selection
Have you ever been arrested or convicted of a crime?
Clear selection
Driver's License Number:
Country of Birth:
Date of Birth:
MM
/
DD
/
YYYY
Emergency Contact Number
Relationship to Emergency Contact
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)
Is your schedule open and flexible?
Do you speak English?
Do you speak Spanish?
Do you smoke?
Clear selection
What is your salary requirement per hour for a new job?
Do you drive?
Clear selection
Do you own a car?
Clear selection
Model/Make of your car:
i.e., Mazda
Year of your car:
i.e., 2014
Would you be willing to transport the children in your vehicle?
Clear selection
Would you be willing to use the employer's vehicle?
Clear selection
Do you have any driving tickets in the last 3 year?
Clear selection
If yes, please explain...
Do you receive text messages on your phone?
Clear selection
What did you do in your country?
Do you swim?
Clear selection
Will you clean the family's clothes?
Clear selection
Do you iron?
Clear selection
Would you be willing to cook for parents?
Clear selection
Would you be willing to cook for kids?
Clear selection
Do you observe dietary laws?
Clear selection
If yes, which dietary laws?
Do you like animals?
Clear selection
Are you allergic to animals?
Clear selection
Will you take care of the kids at night?
Clear selection
Are you willing to clean bathrooms?
Clear selection
Are you willing to clean up after the children?
Clear selection
Are you willing to wear a unifom?
Clear selection
Do you have newborn experience?
Clear selection
Will you follow a schedule?
Clear selection
Did you take courses in newborn care?
Clear selection
Experience with twins?
Clear selection
Experience with triplets?
Clear selection
If you are a live in candidate, will you share a bathroom with a child?
Clear selection
Are you CPR certified?
Clear selection
If certified, when does it expire?
If not certified, would you be willing to take CPR classes?
Clear selection
Are you willing to change diapers?
Clear selection
Are you willing to travel with the family?
Clear selection
Are you willing to travel with the family - by car?
Clear selection
Are you willing to travel with the family - by plane?
Clear selection
Did you attend college?
Clear selection
If yes, how many years did you attend?
If yes, what specialty courses?
Reference 1: Name of Employer
Reference 1: Phone Number of Employer
Reference 1: What month and year did you start?
i.e., 12/2010
Reference 1: What month and year did you end?
i.e., 5/2012
Reference 1: How old were the children when you started the job?
i.e, 6 month old and 3 year old
Reference 1: What did you do for the family?
Check all that apply
Reference 1: Reason for leaving the job?
Reference 1: What was your salary per hour when you started the job?
i.e., $12 per hour
Reference 2: Name of Employer
Reference 2: Phone Number of Employer
Reference 2: What month and year did you start?
i.e., 2/2011
Reference 2: What month and year did you end?
i.e., 6/2013
Reference 2: How old were the children when you started the job?
i.e, 6 month old and 3 year old
Reference 2: What did you do for the family?
Check all that apply
Reference 2: Reason for leaving the job?
Reference 2: What was your salary per hour when you started the job?
i.e., $10 per hour
Reference 3: Name of Emplyoer
Reference 3: Phone Number of Emplyoer
Reference 3: What month and year did you start?
i.e., 2/2011
Reference 3: What month and year did you end?
i.e., 6/2013
Reference 3: How old were the children when you started the job?
i.e, 8 month old and 2 year old
Reference 3: What did you do for the family?
Check all that apply
Reference 3: Reason for leaving the job?
Reference 3: What was your salary per hour when you started the job?
i.e., $11 per hour
When can you start working a new job for a family?
How did you hear about Class Act Nannies, LLC?
*******Hit Submit Now - The last questions are for office use only.
M
Clear selection
C
Clear selection
A
K
Clear selection
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.