Apply for a Domestic Job Orange County CA

General Information

Last Name *

First Name *

MI *

Home Phone *

Cell Phone *

Address *

City *

State *

Zip *

Email *

Date of Availability *

Classification

Minimum Salary *

Hourly

Annually

Geographical area(s) preferred? (in order of preference)

Are you a U.S. Citizen? *

Yes

No

If No, can you legally work in the U.S.? *

Yes

No

Work Permit

Do you have a Driver's License? *

Yes

No

Driving Record *

Excellent

Good

Fair

Moving Violations? *

Yes

No

If Yes, please explain and give dates: *

Are you willing and able to travel? *

Yes

No

Ocassional/Local? *

Yes

No

Out of State/Country? *

Yes

No

Passport? *

Yes

No

Do you like animals? *

Yes

No

Are you allergic to any animals? *

Yes

No

Which animals? *

Personal Information

Have you ever been convicted of a misdemeanor or felony?

Yes

No

If yes, please explain

Do you have children?

Yes

No

If yes, what are their ages?

How many living at home?

Who will take care of your children while you are working?

Date of Birth

Health

Describe overall health

Excellent

Fair

Poor

Do you smoke?

Yes

No

Do you drink?

Yes

No

Are you currently covered by health insurance?

Yes

No

Can you lift?

Yes

No

Number of pounds

Do you take any prescription drugs?

Yes

No

If yes, give name and purpose

Education

Have you completed highschool? *

Yes

No

Level of Education *

Diploma

GED

College

Degree

Major

Certifications:

Are you registered with any other domestic / employment agency(s)? *

Yes

No

If yes, please list agency names *

Domestic Experience

Please list at least 2 positions by using the "Add Experience" button below.

Employer's Name *

From *

To *

City, State, Zip *

Salary *

Duties (including age of children, if childcare) *

Reason for leaving *

Name and position of person to contact for reference

Reference Phone Number

Add Experience Remove Experience

Document Upload

File Upload *

Maximum file size: 20.97MB

Agreements

I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company’s service, if employed. I understand that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment, and that my continued employment depends upon the will of the company or myself. I authorize and understand that a criminal background check may be ordered and that any negative information discovered may or may not be the sole reason for denial of employment.

Check box below to agree *

I Agree

1. Applicant wishes the Agency (CES) to help find a position as a domestic worker or other household classification.

2. The applicant certifies those answers to all questions on the employment application are true and correct, and that all information given to our consultant is accurate as stated on the application or when interviewed at the agency.

3. As consideration for Agency’s help in finding a position for applicant, applicant agrees that they will immediately inform the agency that they have been offered employment by a client referred by agency.

4. Applicant agrees to return Agency’s calls promptly.

5. Applicant agrees to inform agency when they have registered or accepted a position through another agency or otherwise unavailable for employment.

6. Applicant holds free and harmless for any breaches of the employment agreement between the applicant and employer. Agency is solely a referral service and is not a part of the agreement between the applicant and the employer.

I hereby state that I am legally entitled to work in the United States and that I am either a citizen, resident legal alien or possess employment authorization from the INS (Immigration Naturalization Service).