Application Form

1
Please enter your name.* This field is required.
First Name
Last Name
2
Phone Number* This field is required.
Please enter a valid phone number.
3
Email* This field is required.
example@example.com
4
Home Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
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American Samoa
Andorra
Angola
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Benin
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Brazil
Brunei
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Canada
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Chad
Chile
China
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Cote d'Ivoire
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Cuba
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Mali
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Mayotte
Mexico
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Montserrat
Morocco
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Namibia
Nauru
Nepal
Netherlands
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New Caledonia
New Zealand
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Nigeria
Niue
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Poland
Portugal
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Senegal
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eSwatini
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Vietnam
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Western Sahara
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Other
Country
5
Referral Source* This field is required.
Indeed
ZipRecruiter
Facebook
Instagram
Other
6
If someone referred you, please list their name and your relationship to them.
7
Please upload an updated resume. * This field is required.
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Max. file size: 10.6MB
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8
How many years of childcare experience do you have?* This field is required.
less than a year
1- 3 years
3-5 years
5- 10 years
10+ years
9
What kind of childcare experience do you have?* This field is required.Select all that apply
Newborn Care
Infant Care
Toddler Care
Babysitting
Nannying
Daycare/ Childcare Center
K-5 Education
Special Needs
Parent/ Guardian
10
List any childcare-related certifications and degrees.
11
How soon can you start?
Date
Year
Month
Day
12
What is your general availability?* This field is required.Select all time frames you are mostly available (does not need to be exact).
Mostly available any time
Before 9a
9a-12p
12p- 3p
3p-6p
6p-9p
After 9p
MONDAY
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TUESDAY
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WEDNESDAY
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THURSDAY
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FRIDAY
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SATURDAY
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SUNDAY
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MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
Mostly available any time
Row 0, Column 0
Before 9a
Row 0, Column 1
9a-12p
Row 0, Column 2
12p- 3p
Row 0, Column 3
3p-6p
Row 0, Column 4
6p-9p
Row 0, Column 5
After 9p
Row 0, Column 6
Mostly available any time
Row 1, Column 0
Before 9a
Row 1, Column 1
9a-12p
Row 1, Column 2
12p- 3p
Row 1, Column 3
3p-6p
Row 1, Column 4
6p-9p
Row 1, Column 5
After 9p
Row 1, Column 6
Mostly available any time
Row 2, Column 0
Before 9a
Row 2, Column 1
9a-12p
Row 2, Column 2
12p- 3p
Row 2, Column 3
3p-6p
Row 2, Column 4
6p-9p
Row 2, Column 5
After 9p
Row 2, Column 6
Mostly available any time
Row 3, Column 0
Before 9a
Row 3, Column 1
9a-12p
Row 3, Column 2
12p- 3p
Row 3, Column 3
3p-6p
Row 3, Column 4
6p-9p
Row 3, Column 5
After 9p
Row 3, Column 6
Mostly available any time
Row 4, Column 0
Before 9a
Row 4, Column 1
9a-12p
Row 4, Column 2
12p- 3p
Row 4, Column 3
3p-6p
Row 4, Column 4
6p-9p
Row 4, Column 5
After 9p
Row 4, Column 6
Mostly available any time
Row 5, Column 0
Before 9a
Row 5, Column 1
9a-12p
Row 5, Column 2
12p- 3p
Row 5, Column 3
3p-6p
Row 5, Column 4
6p-9p
Row 5, Column 5
After 9p
Row 5, Column 6
Mostly available any time
Row 6, Column 0
Before 9a
Row 6, Column 1
9a-12p
Row 6, Column 2
12p- 3p
Row 6, Column 3
3p-6p
Row 6, Column 4
6p-9p
Row 6, Column 5
After 9p
Row 6, Column 6
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13
For which service area are you applying?
CSRA/ Augusta
Metro Atlanta
14
Which of these areas are you able to reliably commute to provide care services?Select all that apply
Bartow- Adairsville, Cartersville, White
Cherokee- Woodstock, Ball Ground, Canton
Clayton- Jonesboro, Morrow, Lovejoy, Riverdale
Cobb- Acworth, Austell, Marietta, Powder Springs, Kennesaw, Smyrna
Dekalb- Avondale Estates, Dunwoody, Decatur, Brookhaven, Lithonia, Stone Mtn, Chamblee, Doraville, Tucker, Stonecrest
Douglas- Douglassville
Fayette- Fayetteville, Peachtree City, Tyrone
Forsyth- Cumming
Fulton- Atlanta, Alpharetta, Johns Creek, Roswell, Sandy Springs, East Point, College Park, Hapeville, Union City, Fairburn
Gwinnett- Berkeley Lake, Braselton, Buford, Dacula, Duluth, Grayson, Lawrenceville, Lilburn, Loganville, Peachtree Corners, Snellville, Suwanee, Norcross, Sugar Hill
Hall- Flowery Branch, Gainesville, Buford, Braselton, Clermont, Lula
Henry- Hampton, Locust Grove, McDonough, Stockbridge
Paulding- Braswell, Dallas, Hiram
Rockdale- Conyers
15
Are you able to reliably commute?* This field is required.Select all that apply
I am a licensed driver.
I have my own vehicle to reliably commute.
I am comfortable using my vehicle for work, including transporting children.
I do not have my own vehicle but I feel comfortable driving a vehicle provided by the client.
I am not a licensed driver.
I plan to arrange transportation to and from work as needed (ex: dropped off by friends/family, rideshare, public transportation)
16
Are you COVID vaccinated?* This field is required.
Yes- vaccinated and boosted
Yes- Fully vaccinated (no boosters)
Partially- I received 1 dose
No
17
Reference #1* This field is required.
Reference #1 Full Name
Reference #1 Phone Number
Reference #1 Email Address
18
Reference #2* This field is required.
Reference #2 Full Name
Reference #2 Phone Number
Reference #2 Email Address
19
Reference #3* This field is required.
Reference #3 Full Name
Reference #3 Phone Number
Reference #3 Email Address
20
Reference #4* This field is required.
Reference #4 Full Name
Reference #4 Phone Number
Reference #4 Email Address
21
Reference 5* This field is required.
Reference #5 Full Name
Reference #5 Phone Number
Reference #5 Email Address
22
Upload a simple headshot to include on your profile.* This field is required.Share your best friendly smile. Please no group pictures, duck lips or heavy filters.
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Max. file size: 10.6MB
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