Be A Home Buddy

*Date:

/ /

*Name:

*Address:

*City:

*State:

*Zip:

*Home Phone:

- -

Work Phone:

- - x

Cell Phone:

- -

*Email:

Fax:

- -

*I am a citizen of
the United States:

If no, what country?:

*I am legally able to
accept work in the
United States:

HomeBuddies & NannyMN are only able to place candidates with legal work authorization in the United States

*Have you ever been
convicted of a
Felony or
Misdemeanor?:

If Yes, please complete explain below

Please Explain
Felony or
Misdemeanor:

(chars left: 255)

*What type of
position are you
looking for?:

Hold Cntrl key to
make multiple selections. If other, please explain below

Explain "other"
postiion:

*What type of work
arrangement are you
looking for?:

Select Live-in or Live-out or on-call and hold press Cntrl to select hours

Date available to
start:

/ /

Expected salary
range:

Length of
committment you are
willign to give:

Days available to
work:

Days available to work:

Hold Cntrl Key to make multiple selections

Hours available to
work (From):

:	Explain below if necessary

Hours available to
work (To):

:	Explain below if necessary

Explain Hours:

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*Please select all
the duties you are
willing to perform:

To make multiple selections hold the Cntrl key when selecting. Explain "other" postion below

Explain "other"
duties:

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	For Childcare Applicants Only

Please select all
Age Ranges/Multiples:

CHILDCARE APPLPICANTS ONLY. Hold the Cntrl key to make multiple selections

Special Needs
Experience::

CHILDCARE APPLPICANTS ONLY. Hold the Cntrl key to make multiple selections

What Activities
would you like to
share with Children?:

(chars left: 255)

CHILDCARE APPLICANTS ONLY

Describe your family
background:

(chars left: 255)

CHILDCARE APPLICANTS ONLY

What can children
benefit from your
care?:

(chars left: 255)

CHILDCARE APPLICANTS ONLY

What form of
discipline to you
believe is most
effective?:

(chars left: 255)

CHILDCARE APPLICANTS ONLY

Why are you
interested in doing
this type of work?:

(chars left: 255)


	All Aplicants

How well are you
suited for this type
of work?:

(chars left: 255)

What are your
long-term career
goals?:

(chars left: 255)

Comments on your
Interest describe
religious
considerations:

(chars left: 255)

*What is the highest
level of education
you’ve completed?:

*Date Attended From:

/ /

*Date Attended To:

/ /

*School(s) Attended:

School from which you attained your highest degree

*Degree(s) Received:

*Are you currently
certified in CPR?:

If yes, what is
covered on your
certificate?:

Hold Cntrl key and click to make multiple selections

Certification
Expiration Date:

/ /

*Are you currently
certified in First
Aid?:

If yes:

Certification
Expiration Date::

/ /

*Do you have any
additional Childcare
education?:

If Yes:

(chars left: 255)

*Are you Lifeguard
Certified?:

*Can you swim?:

*Do you smoke?:

List Any Pets you
are NOT willing to
work with or around::

(chars left: 255)


	The following 4 Questions are OPTIONAL for all candidates

Marital Status:

Explain "other"
maritial status:

(chars left: 255)

If you have
children, tell us
about them: (Name,
Gender, Ages):

(chars left: 255)

1

If you do have
children, do you
have to take them to
your job?:


	All Aplicants

What languages do
you speak and how
fluent?:

*Are you willing to
travel with the
family if necessary?:

*Are you willing to
work in a home where
there are firearms?:

If comments, please add below

Comment:

(chars left: 255)

*Are you working with
other agencies?:

If Yes, add other agency below

Otehr Agency Name:

*Are you looking for
a position on your
own?:

*Do you own a car?:

Make:

Model:

Who can we thank for
referring you to
HomeBuddies? (Please
be specific):

List "other" below

"Other" Thank You :


	Employment History/Non-Personal References


	List ALL employment for last 7 years: Childcare, Domestic, Corporate, etc. Most Recent First

Most Recent
Employment -
Employer:

Employment Dates
From:

/ /

Employment Dates To:

/ /

Reference Name:

May we contact?:

Still Employed?:

Home Phone:

- -

Work Phone:

- - x

Cell Phone:

- -

City/State:

Email:

Your Position:

Was this Position:

Duties:

(chars left: 255)

If you cared for children,
include how many, gender
and ages at time of hire

Reason for Leaving:

(chars left: 255)


	Employer 2

Employer:

Employment Dates
From:

/ /

Employment Dates To:

/ /

Reference Name:

May we contact?:

Still Employed?:

Home Phone:

- -

Work Phone:

- - x

Cell Phone:

- -

City/State:

Email:

Your Position:

Was this Position:

Duties:

(chars left: 255)

If you cared for children,
include how many, gender
and ages at time of hire

Reason for Leaving:

(chars left: 255)


	Employer 3

Employer:

Employment Dates
From:

/ /

Employment Dates To:

/ /

Reference Name:

May we contact?:

Still Employed?:

Home Phone:

- -

Work Phone:

- - x

Childcare
Child Laundry
Family Laundry
Child Bathing
Caring for Special Needs Child
Transporting Child
Ironing
Cooking for Children
Light Housekeeping
Heavy Housekeeping
Organizational Projects
Plant Care
Pet Care
Travel
Transporting Professional
Party Planning
Travel Planning
Cookign for Family
Cooking for Parties
Domestic Shopping
Running Errands
Domestic Secretarial Duties
Managing Domestic Staff
Other