Candidates

Dear Prospective Nanny/Governess/Household Help/Eldercare/Estate & Corporate Job Applicants,

Thank you for contacting Cass Company LLC. We are a referral service for Nannies, Nanny/ Managers, Governess's, Household, Estate and Corporate help as well as Eldercare/Companions, Personal & Executive Assistants, Caretaker's & Estate Couples, Butler's Maids, Groundskeepers, Baby nurses, Tutors, Social Secretaries, Gentleman's Assistants, Ladies Assistant's, Nurses Aides, Baby Aide's and more.

Thank you for your interest in placement through Cass and Company, LLC we look forward to working with you.

Please complete, in full, the following application and submit when complete. In addition to the application, you need to submit the following:

A letter about yourself, including something about your life, where you were born, your childhood, what you have done with your life, what goals you may have, and why you would like to do the kind of job for which you are applying.
An enlarged, clear copy of your driver's license: E-mailed, Faxed or Mailed
Two recent, good and clear pictures of yourself: E-mailed, Faxed or Mailed
Three to five written references, letters of recommendation or list of references
Download and print the CORI Request Form: E-mailed, Faxed or Mailed
Download and print the Information Verification Release Form: E-mailed, Faxed or Mailed

This additional information increases your employment offers. We encourage you to complete the application and forward this additional information as soon as possible and we can start submitting your information on you to potential employers.

The health section must also be taken to your Primary Care Physician to be completed by your doctor and it's an employment physical requested by employers.
Lastly all Cass & Company job listings are confidential: If you are interviewing and accept a position by a Cass & Company Client you Must report it to Cass & Company and never give the client information to anyone, e.g. Friends, family, acquaintances etc. etc. A full placement fee will be due from you if you give client information that Cass & Company gives to you to a client; non-registered agent, or candidate and they accept/call the position. Otherwise there is never a fee charge to job applicants by Cass Company LLC.

Please send your information to Cass & Company LLC 28 State St. Suite 1100, Boston , Ma 02109 or fax it to 1-888-453-2236, or E-mail it to jobs@casscompany.com We look forward to working with you.

Sincerely, Sara B. Cassinelli, MS, Administrator & The Staff of Cass & Company

Date Available:

Live In Live Out Live out but stay over when needed

Your Name:
Current Address:
City:
State, Zip:
Home Phone:
Best Time to Reach You:
Work Phone:
Fax:
Home Email:
Date of Birth:
SSN#:
Driver's License Number and State of Issue:
Marital Status:			Married Single Divorced Widowed Other:
Maiden/Other first or last names used( Please List):
Can you make a one-year commitment?:			Yes No

Character References (Priest, Minister, Rabbi, Co-Worker, Long-time Family Friend, etc):

Name	Telephone #	Relationship	Dates

Do your own a car? Yes No

Make & Model:

Would you bring your car with you to your new place of employment?: Yes No

Do you have a good driving record?: Yes No

Any Speeding or other tickets?: Yes No

If yes, when and where for what?:

Any accidents or moving violations Accidents?: Yes No

If yes, when and where for what?:

Any criminal record?: Yes No

If yes, please explain:

Have you ever been arrested?: Yes No

If yes, please explain:

Place of birth? (City, St.):

Alien registration #:

Are you registered with any other nanny agency at this time?: Yes No

If yes, please state name of agency:

Education and Training (Colleges, Technical Schools, Any other Courses, Chef, Hospitality School etc attended and attended/graduated from and other special training)
Types: HS=High School V/T=Vocational/Technical School CO =College O=Other Institution ST=Special Training

Type	Name of Institution	Dates Attended	Degrees Attained

Are you CPR or First Aid Certified? Yes No

Would you be willing to take these courses?: Yes No

Can you cook?

Yes Basic Family Gourmet No

Are you allergic to animals?:

Yes No

If yes, which?:

Are you comfortable working in a home with animals? :

Yes No

Do you swim?

Yes No Beginner Intermediate Advanced

Could you pull a child out of a pool who fell in? :

Yes No

Describe your personality and strengths:

Type of Position: (Check All you would Consider)

Nanny/N/Mgr/Babynurse

Estate Manager

Household Manager

Housekeeper / Adults only

Housekeeper/Child Care

Mother's Helper / Baby's Aide

Companion/Elder Care

Personal / Executive Assistant

Chef/Cook

All Positions Listed

Personal Care Attendant/Nurses Aid

Other

Duties of Position (Nanny only position)

Children's only

All housekeeping

Childcare/Light Housekeeping

Children's laundry
General pickup
Clean up kitchen
Empty dishwasher
Keep bedrooms clean
Make beds
Make meals
Occasional errands
Driving children
Pick up toys
Pick up toy room

Household Manager - everything to the left and below, plus floors, scheduling appointments, etc. (varies for each family)

Days / hours available to work:

***Please check only job responsibilities that you will do: ***

HOUSEKEEPING:

Wash Walls	Wash Windows	Clean Bathrooms
Clean Kitchen	Make Beds	Polish Silver
Wash Clothes	Wash Linens	Wash Dishes & Pans
Hand Wash Clothes	Iron Shirts	Iron Linens
Dust	Vacuum
COOKING:
Gourmet Cooking	Plain Cooking	Family Serving
Prep Assistant	Special Diet Cooking	Family Cooking

HOUSEHOLD MANAGEMENT:

Supervise Staff		Hire Staff	Shopping
Event Planning		Flower Arrangement	Household Budget

Please check what you are willing to do from the list below:

Work on holidays if needed		Work for a parent who works from home
Run errands & grocery shop		Work evenings and weekends

Please answer the following questions if you are applying for a position where you might work in a home with children/ Even if you are not the primary caregiver. Please use a separate piece of paper if additional space is needed.

If Applicable: What age groups of children do you have experience with?
Newborn 6 months to 1yr. 1 to 2 years 2 to 4 5 to 7 7 to 12 Other ages:
Adult Care

Explain Where and When:

If you are applying for a childcare position, how many children have you cared for at one time?

Are there any limitations to the position you are seeking? (i.e. lifting, allergies etc, in school, available part time only, Husband/Wife /Children must relocate with me, must bring cats/dogs etc.)

What do you think it takes to be successful in a field like this?

Can you tell us a little bit about your family background?

Have you lived in any other state or country during your life other than the one you currently live in? Yes No
If yes, please list all cities, states and countries:

If applying for a live-in position, do you have anything to consider, such as pets, Husband, boyfriend, children? If so, explain:

At what job were you the happiest?

What motivates you to put forward your best effort?

If you are leaving your current position, please explain why:

Do you ever get frustrated / angry? When:

Do you have any issues over working for people of different faiths, ethnicity, cultures, etc., other than your own?: Yes No

If you practice a religion, would you need certain days off for this?: Yes No
If yes what days, holidays etc.:

What are your interests and hobbies?:

Do you speak any other languages and, if so, which ones?:

Have you ever-experienced emotional problems? Yes No
Have you ever had counseling? Yes No
If yes, For what, when and are you still in counseling?:

Is there anything in your work/life balance that could create a problem or affect your work performance?:

What have been some of your successes?:

What are your immediate goals and long-term goals? (5 years & 10 years):

What would you list as three of your faults, and why are they negatives?:

Who will be your emergency contact(s) if you take a position through a Cass & Co. referral?:

Name	Telephone Number	Relationship

What is your policy on discipline?:

*** You are not required to answer the following two questions. However, due to the nature of our service, we ask that you consider the importance of the topic. ***

Have you ever been abused?: Yes No

Have you ever abused a child or anyone else?: Yes No

Cass & Co. jobs are one-year commitments and contracts are required to be signed. Is this OK with you?: Yes No

How did you hear about Cass & Co. LLC.?:

Health/Medical Information( Please complete)

Height

Weight

Do you have regular medical check ups?	Yes No
When was your last check up?
Physician's Name
Physician's Address
Date of last T. B. test or chest X-ray
Have you had hepatitis prevention shots?	Yes No
Are you a known hepatitis carrier?	Yes No
Have you ever had hepatitis?	Yes No
Do you have health insurance?	Yes No
Insurance Company
Do you need health insurance?	Yes No
List and explain any major operations/illnesses

Have you ever been told you have any of the following?:
Fainting or dizziness Diabetes High blood pressure Chronic cough Skin diseases Frequent headaches Hernia Varicose veins Serious physical or emotional traumas Difficulty seeing/glasses/contact lenses	Epilepsy or convulsions Nervous or mental disorders Low blood pressure Allergies, asthma, wheezing Deformities or amputations Heart disease Rheumatic fever or arthritis Difficulty hearing/hearing aid
Please explain any questions that you answered yes to:
Are you (or have you been) treated for any neck or back disorder or injury?: Yes No
Do you take any prescribed medications? Please list :
Do you smoke?: Yes No	If Yes, specify amount:
Do you drink?: Never Rarely Occasionally Socially Other Do you take any illegal drugs?: Yes No Would you be willing to take a drug test?: Yes No	Specify amount and how often:
Have you changed (or been advised to change) occupations or residence because of health?: Yes No
Do you have any special medical considerations or physical limitations?: Yes No If yes, please explain:
Do you have any body art or pierced places on your body?: Yes No If yes where?:
WORK HISTORY : ( First is most current or last job) Beginning with your present or most recent job, list all past employers. These employers may be contacted for reference purposes.

1. Name of Company

Complete Address

Telephone Number

Title

Supervisor's Name

Date of Employment
From:

Starting Salary:

Ending Salary:

Reason for Leaving:

If still employed, may we contact?

Yes No

2. Name of Company

Complete Address

Telephone Number

Title

Supervisor's Name

Date of Employment
From:

Starting Salary:

Ending Salary:

Reason for Leaving:

If still employed, may we contact?

Yes No

3. Name of Company

Complete Address

Telephone Number

Title

Supervisor's Name

Date of Employment
From:

Starting Salary:

Ending Salary:

Reason for Leaving:

If still employed, may we contact?

Yes No

4. Name of Company

Complete Address

Telephone Number

Title

Supervisor's Name

Date of Employment
From:

Starting Salary:

Ending Salary:

Reason for Leaving:

If still employed, may we contact?

Yes No

5. Name of Company

Complete Address

Telephone Number

Title

Supervisor's Name

Date of Employment
From:

Starting Salary:

Ending Salary:

Reason for Leaving:

If still employed, may we contact?

Yes No

6. Name of Company

Complete Address

Telephone Number

Title

Supervisor's Name

Date of Employment
From:

Starting Salary:

Ending Salary:

Reason for Leaving:

If still employed, may we contact?

Yes No

7. Name of Company

Complete Address

Telephone Number

Title

Supervisor's Name

Date of Employment
From:

Starting Salary:

Ending Salary:

Reason for Leaving:

If still employed, may we contact?

Yes No

Childcare/Household/Coupes etc Experience:
Please list all employment as well as volunteer work below. Please include the corporate experience as well any kinds of: Domestic/Estate/Management/Eldercare/Child Care (include ages), Corporate, Educational, and work related experience: For Elder's (their ages and list if their were any medical conditions involved( including Alzheimer's Disease) For Child Care: Please list: family/institution's name and telephone number, the dates of employment and whether it was babysitting, nanny care, daycare, teaching, etc.

Please only include positions not listed in general work history.

Type of employment	Name of Family/Institution and telephone number	Dates employed	Job duties

Are there any childcare, or other household, corporate or related experiences that you are not including that you have worked or volunteered for?: Yes No

If there are any childcare-related, household, corporate experiences you are omitting, please explain your reasons for this:

Privacy Policy:
Information collected by Cass & Company, LLC will be used only for the purpose of fulfilling our services which you have requested. Information that you provide to Cass & Company, LLC will not be given to any other parties without your written consent.

I agree not to refer to any client/Applicant (seeking a job) that I am referred to (Via Cass & Company LLC) or give information about, to any agency or person regarding a position Cass Company LLC tells me about. I understand that a fee will be due to Cass & Company LLC of the full placement fee for the client I have been given information about if I transfer/give information regarding Cass Company's property to other person(s)I and it will be my responsibility to pay fee for placement ( regardless if there is a hire ) that to: Cass & Company should I pass on a Name or information about a client/ candidate to others at that time (fees range from *$1250. to $15,000. or more [at this time}. I further understand that all clients' /candidates information is totally confidential and the property of Cass & Company LLC only, a Boston Company.

Check to agree and enter your name here for signature.

© 2006 Cass & Company
Nancy Childcare Placement Agency, Household & Domestic Staffing Services for New England
Boston Massachusetts MA | Providence Rhode Island RI
Maine ME New Hampshire NH Vermont VT Connecticut CT