You start with a blank solution. Then you right click the solution and add a new project, for instance MyApp_iOS and select an iOS template. Next you repeat this for Android and all other platforms you want to support.
You will have to worry about your code sharing strategy. If you want to share one core library, add another project and select "Shared library (PCL)" (http://docs.xamarin.com/guides/cross-platform/application_fundamentals/pcl/) as project type. This one can be referenced from all platforms.
Alternatively if you want to use file linking (http://docs.xamarin.com/guides/cross-platform/application_fundamentals/building_cross_platform_applications/sharing_code_options/), add a standard .NET library and then create a subfolder on all of your platform projects and add existing files from the library. In the dialog choose to "link" the files and do not copy or move them.
I recommend you check out the many available samples like the field service app to get a understanding: http://xamarin.com/prebuilt/fieldservice