Employment Application

Position: Full-time, live in, Cook/Light housekeeper, Outer Banks/Corolla, NC

BASIC INFORMATION

Last Name:  First Name:  Street Address:  City:  State:  -:Select a State:- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code:  Email Address:  Home Phone:  Work Phone:  Cell Phone:

Which is the best number to contact you on: Home Work Cell Have you ever gone by any other name: Yes No If yes, please list names: How long have you lived at your current address: If less than a year, what is your previous address:   Street Address: City: State: -:Select a State:- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code:

Are you legal to work in the U.S.: Yes No What type of position are you applying for: Live-In Live-Out Either   Full-Time Part-Time Number of years of Domestic experience: Date you are available to start: Will you relocate for a position: Yes No What compensation are you seeking: Are you available to travel with the family: Yes No Are you available to work overtime: Yes No What languages do you speak (please list all):

EMERGENCY CONTACT INFORMATION

Who can we contact in the case of an emergency: Street Address: City: State: -:Select a State:- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code: Emergency Contact Phone Number: What is your relationship with this person:

PERSONAL INFORMATION

Are you 18 or older? Yes No Can you provide proof of your age? Yes No What are your hobbies? Are you willing to work in a house with children: Yes No Have you ever been convicted of a felony: *The existence of a criminal record is not an absolute bar of employment. Yes No If yes, please explain: Do you have a valid driver's license: Yes No Do you have a clean driving record: Yes No If no, please explain: Are you willing to take a physical examination prior to employment: Yes No Can you perform the job's essential functions with or without limitations?: With Limitation Without Limitation If "With", please explain: Can you meet the job's attendance requirements?: Yes No If no, please explain: Do you smoke: Yes No   Are you willing to work in a home with animals: Yes No If not, please explain: Are you comfortable working with a family of a different religion than you?: Yes No

EDUCATION HISTORY

High School: Year Graduated: College /University/ Trade Schools , Etc. School: Years Attended: Year Graduated: Major/Degree: Medical Skills and/or Certificates:

TRANSPORTATION INFORMATION

Do you have access to a reliable car: Yes No Have you ever been in a car accident: Yes No

EMPLOYMENT and VOLUNTEER HISTORY

Former Employer and Volunteer Position Name #1: Address: Phone Number: Start Date: End Date: Starting Compensation: Ending Compensation: Job Title: Job Description: Reason for leaving this position:     Former Employer and Volunteer Position Name #2: Address: Phone Number: Start Date: End Date: Starting Compensation: Ending Compensation: Job Title: Job Description: Reason for leaving this position:     Former Employer and Volunteer Position Name #3: Address: Phone Number: Start Date: End Date: Starting Compensation: Ending Compensation: Job Title: Job Description: Reason for leaving this position:

CHARACTER REFERENCES

Name: Address: Phone Number: What is your relationship with this person: How many years have you known this person:     Name: Address: Phone Number: What is your relationship with this person: How many years have you known this person:     Name: Address: Phone Number: What is your relationship with this person: How many years have you known this person:       Please describe how you would like Estate Domestics to describe YOU to your future family: Please explain why you feel you are an excellent candidate for domestic placement:

COOK/CHEF POSITION SPECIFIC INFORMATION

How well do you rate your cooking: Average Above Average Gourmet Are you willing to shop for groceries: Yes No Are you culinary trained: Yes No Are you familiar with current diet trends: Yes No If so, which please check all that you are familiar with: Atkins Kosher South Beach Weight Watchers Others Can you provide photos and menus: Yes No Favorite type of cooking: Can you organize and cater a party: Yes No How many guests can you accommodate? Can you maintain a weekly budget and accounting ledger: Yes No Are you willing to wear a uniform if employer requires it: Yes No Do you own your own uniform: Yes No Do you know how to pair wines: Yes No

I agree to the terms and conditions.

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