Domestic Placement Network

Edit Application

Please complete all sections of the application. The more information we have about you, the better we can match you with job openings.

* - Required Field

Contact Information

ID:		* Valid characters: A-Z, 0-9
Password:		* Valid characters: A-Z, 0-9
Password Again:		*
E-mail:		*
First Name:		*
Last Name:		*
Address:		*

City:		*
State:		*
Province:
Zip Code:		*
Country:		*
Phone Cell:
Phone Work:
Phone Home:		*
Pager:
Fax:

How Did You Find Us?

How did you find The Domestic Placement Network?

Eligibility

Are you a US citizen?

If no, where are you a citizen?

Are you legally eligible for employment in the USA?

Do you have a current passport?

Date you are available to begin a new position:
(Format: mm-dd-yyyy)

Are you currently employed?

If yes, does your employer know you are leaving?

Have you ever served in the military?

If yes, give branch and dates:

Do you have your own transportation?

Candidate Preferences

Position/Title Applied for:		*
Second choice or combined position (can be same as above):		*
Years experience in the position(s) you are applying for:		*
If working as a couple, partner's name is:
Your most recent salary in this position (US$):
Salary Desired:
Minimum salary you would accept for the "perfect position":
Can you give a minimum one year commitment?
Are you willing to relocate?		*
Desired Location:
Will you work in a home with pets?		*
Will you work in a home with children?		*
Are you willing to travel with an employer?		*

Education/Training

High School (or equivalent) Name:
High School Location:
Graduation Date:
College (or equivalent) Name:
Years attended:
Degree Earned and When(Year):
Professional, Trade, or Other School:
Dates Attended:
Degree Or Certificate:
What is your typing speed(wpm)?
Please rate your computer skills:
What programs are you skilled in?
Please list all languages spoken:

Personal/Medical Data

Marital Status and How Long:
Do you have children living with you?
If yes, what are their ages?
Sex:		*
Do you have any physical limitations that would affect your abilities in the position you are applying for?
If yes, please explain:
Do you smoke?
Would you be willing to take a physical exam and/or drug test for a potential employer?

Personal Statement

Please write a brief personal statement including the type of work you are seeking, why you want to work in this field, what type of person you are, and why you would be valuable to an employer.

Terms & Conditions

Please read over the agreement below and check the box to indicate that you understand the terms.

1.  I understand that I may be required to provide additional information to agencies that choose to represent me for employment. I may also be required to authorize a thorough background check including: criminal background; civil litigation history; credit report; social security verification; etc.  No party may conduct these searches without my signed authorization.

2. I understand that agencies may have different terms and conditions for representing me.  It is my responsibility to learn all of the policies and procedures of any agency I elect to work with in my search for employment.

3.  I agree to notify Domestic Placement Network (DPN) or the agency who referred me of all changes in my status including: address changes, offers of employment, contact information changes, etc.  I can do this by contacting DPN or the agency and/or making the appropriate changes to  my online application.

4.  I understand that acceptance of my application by Domestic Placement Network is not a guarantee that DPN or any agency will represent me or find suitable employment for me.

5.  I understand that Domestic Placement Network is not liable for the actions of any employer or agency.  I agree to indemnify and hold harmless Domestic Placement Network, its employees, officers, and agents for and from all claims, including attorney fees and court costs, made by any person when such claim arises out of my actions or the actions of any party to whom I have been referred directly or indirectly by DPN.

Yes, I agree. *

� 2002- Domestic Placement Network, LLC.

For more information call (877) 206-5262.

International callers (805) 640-3608.