Working Solutions, Inc.
51 East 42nd Street,
Suite 1511.
New York, NY 10017
Telephone: (212) 922-9562
Fax: (212) 922-9610
Email: workingsolution@aol.com

If you’re looking for a domestic career and have excellent qualifications, recent checkable references, legal status to work in the United States, we’ll be happy to hear from you! Please fill out the following application.

Basic Information
Today's Date
Last Name
First Name
Address
City
State
Zip
Home Number
Mobile Number
Emergency Number
Email Address
Education completed?
Major (if applicable)
Legal Status
Marital Status
Are you currently employed?Yes No 
Name and Address of current Employer
How did you find out about our Agency?
Name of Referral (if applicable)
Have you ever been convicted of a crime?Yes No 
If 'Yes', please describe
.
Do you have allergies to any animals?Yes No 
If 'Yes', which animals?
Do you drink?Yes No 
If 'Yes', how often?
Do you smoke?Yes No 
If 'Yes', are you willing to restrict smoking to non-work hours?Yes No 
Are you taking any medications that would interfere with your ability to perform the job duties?Yes No 

Position being sought
Date you can start
Live-In positionyes no 
Live-Out positionyes no 
Part-Timeyes no 
Full-Timeyes no 
Weekendsyes no 
Occasional Babysittingyes no 
Baby Nurse yes no 
Nanny yes no 
Housekeeper yes no 
Chef yes no 
Cook yes no 
Chauffeur yes no 
House Manager yes no 
Houseman yes no 
Personal Assistant yes no 
Min. Salary
Desired Location
Days and Hours Preferred
Will you do Housekeeping?Heavy Light 
Will you cook?
How many children are you comfortable caring for?
With what ages do you feel most comfortable working?
Are you willing to work on a short-term basis?Yes No 

Skills
Do you speak any foreign languages?
Other
Do you have any computer skills?Yes No 
List Computer Skills
Do you play any instruments?Yes No 
List instruments
Have you worked with children with special needs before?Yes No 
If 'Yes', please describe
.
Were you ever terminated from a job?Yes No 
If 'Yes', please describe:
Are you First Aid/CPR trained?Yes No 
Do you swimYes No 
How well?

Driving/ Travel
Are you flexible to travel?Yes No 
Live-in for the summer?Yes No 
Do you have a valid Driver's License?Yes No 
License No.
Exp. Date
Do you have a car?Yes No 

Employment History 1
From Date
To Date
Employer's Name
Spouse's Name
Employer's Address
Phone No.
Position
Other
No. of Children
Ages (when started)
Salary
Reason for leaving

Employment History 2
From Date
To Date
Employer's Name
Spouse's Name
Employer's Address
Phone No.
Position
Other
No. of Children
Ages (when started)
Salary
Reason for leaving

Employment History 3
From Date
To Date
Employer's Name
Spouse's Name
Employer's Address
Phone No.
Position
Other
No. of Children
Ages (when started)
Salary
Reason for leaving

Other Employment
Employer's Information
.

Terms Of Use

All information that I have given in this application is true in all respects. I understand that this information will be relied upon any decision to hire me. If any information in this application is found to be false, I may be immediately dismissed without further obligation on the part of my employer.

I understand that any job offers I will get from any client referred to me at any time by Working Solutions, Inc. can not be entertained and accepted without the consent of Working Solutions, Inc.


I understand that Working Solutions, Inc. is not liable or responsible for any act or conduct undertaken by me or by anyone who may hire me. I confirm that I received a copy of the 'Domestic or Household Employees Statement of Employees Rights and Employment Responsibilities'.


By clicking the 'submit' button, you are agreeing to the terms listed




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You can also email your resume to workingsolution@aol.com
Please remember: There is never a fee to an Applicant!