<div class="vc_col-sm-12"><p style="text-align:center; font-size: 20px;margin-top:20px;">Today's Date</p></div>

<div class="vc_col-sm-12" style="margin-bottom:20px;"><span>[date* your-date min:2019-01-01 max:2040-12-30 class:required]</div>

<div class="vc_col-sm-6">[text* your-first-name placeholder "First Name*"]</div>

<div class="vc_col-sm-6">[text* your-last-name placeholder "Last Name*"]</div>

<div class="vc_col-sm-12">[textarea* current-addres placeholder "Current Addres*"]</div>

<div class="vc_col-sm-6">[text your-street placeholder "Street"]</div>

<div class="vc_col-sm-6">[text your-city placeholder "City"]</div>

<div class="vc_col-sm-6">[text your-state placeholder "State"]</div>

<div class="vc_col-sm-6">[text your-zip placeholder "ZIP / Postcode"]</div>

<div class="vc_col-sm-6">[text* your-phone placeholder "Phone*"]</div>

<div class="vc_col-sm-6">[email* your-email placeholder "Email*"]</div>


<div class="vc_col-sm-12">[text your-emergency placeholder "Emergency contact (name, phone)"]</div>

<div class="vc_col-sm-12">[textarea your-previous placeholder "Previous places of residence (States) in the last five years"]</div>

<div class="vc_col-sm-6" style="margin-bottom:10px;">[select legal-job "Do you have a legal right to work in the USA?" "Yes" "No"]</div>

<div class="vc_col-sm-6">[text valid-license placeholder "Do you have a valid driver's license?"]</div>

<div class="vc_col-sm-6">[text your-carwork placeholder "Will you use your car for work?"]</div>

<div class="vc_col-sm-6">[text primary-language placeholder "What is your primary language?"]</div>

<div class="vc_col-sm-6">[text other-landuage placeholder "What other languages do you speak?"]</div>

<div class="vc_col-sm-6">[text highes-education placeholder "What is your highes level of education?"]</div>

<div class="vc_col-sm-12"><p style="text-align:center; font-size: 20px; margin-top:20px;">When can you start work?</p></div>

<div class="vc_col-sm-12" style="margin-bottom:20px;"><span>[date* start-work min:2019-01-01 max:2040-12-30 class:required]</div>

<div class="vc_col-sm-12">[textarea your-skils placeholder "What skills do you have?"]</div>

<div class="vc_col-sm-12" style="margin-bottom:10px;">[select crime-your "Have you ever been convicted of a crime, felony or misdemeanor?" "Yes" "No"]</div>

<div class="vc_col-sm-6" style="margin-bottom:10px;">[select comfort-pets "Are you comfortable with pets?" "Yes" "No"]</div>

<div class="vc_col-sm-6" style="margin-bottom:10px;">[select your-smoke "Do you smoke?" "Yes" "No"]</div>

<div class="vc_col-sm-6" style="margin-bottom:10px;">[select your-drink "Do you drink?" "Yes" "No"]</div>

<div class="vc_col-sm-6" style="margin-bottom:10px;">[select your-certified "Are you CPR and first AID certified?" "Yes" "No"]</div>

<div class="vc_col-sm-12" style="margin-bottom:10px;">[select your-certified2 "RF nor, are you willing to become certified?" "Yes" "No"]</div>

<div class="vc_col-sm-12">[textarea years-experience placeholder "Years of experience as a nanny? (Describe in Detailes)"]</div>

<div class="vc_col-sm-12">[textarea other-experience placeholder "Experience in other housework positions? (Describe in Detailes)"]</div>

<div class="vc_col-sm-12">[textarea special-children placeholder "Have you ever had experience with special needs / handicaps children (Describe in Detailes)"]</div>

<div class="vc_col-sm-12"><p style="text-align:center; font-size: 20px; margin-top:20px;">Position you are looking for?</p></div>

<div class="vc_col-sm-12" style="display:flex; justify-content:center;">[checkbox* your-position use_label_element "Nanny" "Babysitter" "Housekeerer" "Dog walker" "Other animal sitter" "House assistent" "Elderly care" "Other"]</div>

<div class="vc_col-sm-12"><p style="text-align:center; font-size: 20px; margin-top:20px;">Working hours sought?</p></div>

<div class="vc_col-sm-12" style="margin-bottom:10px; display:flex; justify-content:center;">[checkbox* your-hourswork use_label_element "Any" "Mornings" "Afternoons" "Evenings" "Live in" "Live out" "Part time" "Full time" "Other"]</div>

<div class="vc_col-sm-12">[text comments-hours placeholder "Specific comments"]</div>

<div class="vc_col-sm-12"><p style="text-align:center; font-size: 20px; margin-top:20px;">Working days sought?</p></div>

<div class="vc_col-sm-12" style="display:flex; justify-content:center;">[checkbox* your-daywork use_label_element "Monday" "Tuesday" "Wednesday" "Thursday" "Friday" "Saturday" "Sunday"]</div>

<div class="vc_col-sm-12" style="margin-top:20px;">[textarea describe-job placeholder "Please describe your childcaare history or different position in detailes and your responsibilities. Indicate full time or part time, number of kids, age, etc..."]</div>

<div class="vc_col-sm-12">[textarea maximum-child placeholder "What is the maximum number of children, regularly of household you a willing to care for?"]</div>

<div class="vc_col-sm-12">[text pay-range placeholder "What is your ideal pay range?"]</div>

<div class="vc_col-sm-12" style="margin-bottom:10px;">[select your-coomitmente "Will you be able to make a one year commitment" "Yes" "No"]</div>

<div class="vc_col-sm-12">[textarea references-child placeholder "References information (name of families, address, phone number)"]</div>

<div class="vc_col-sm-12 sc_form_field_button">[submit "Send form"]</div>