CHILDCARE SPECIALIST APPLICATION

CHILDCARE SPECIALIST APPLICATION FORM
Thank you for your interest in Dream Childcare and Newborn Care Staffing Agency LLC's placement services. Before any placements or interviews a $200 Registration/Application fee is required.

Kindly complete this Childcare Specialist Application Form and submit proof of payment. We accept check, money order or bank transfer.
Please choose the area where you currently live*

BrooklynQueensManhattanBronxWestchester CountyLong IslandOther
Parent /Guardian #1*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Occupation*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent /Guardian #2

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Occupation
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
We are looking for? (Please check appropriate boxes)*

Live-inLive-outTemporaryFull TimePart TimeWeekendDriverNon-driver
If a driver, will a car be provided?*

YesNo
Start Date*

MonthDayYear
Date
Children's Information Child 1:*

First NameLast Name
Date of Birth:*

MonthDayYear
Date
Gender:*

MaleFemale
Grade: *
Special Interests or Hobbies: *
Child 2:

First NameLast Name
Date of Birth:

MonthDayYear
Date
Gender:

MaleFemale
Grade:
Special Interests or Hobbies:
Child 3:

First NameLast Name
Date of Birth:

MonthDayYear
Date
Gender:

MaleFemale
Grade:
Special Interests or Hobbies:
Child 4:

First NameLast Name
Date of Birth:

MonthDayYear
Date
Gender:

MaleFemale
Grade:
Special Interests or Hobbies:
Are you expecting any more children within the next year?*

YesNo
If any of your children have any special needs, please explain:*
What are some of the responsibilities the Childcare Specialist /Nanny will have? *
What are the desired qualities you are looking for in your ideal Childcare Specialist / Nanny?*
Accommodations to be provided: (Please check appropriate boxes)*

Private bedroomPrivate bathroomShared bathroomPhoneHealth InsuranceTravellingOther
Have you ever employed a Childcare Specialist / Nanny before?*

YesNo
If yes, why is the Childcare Specialist /Nanny no longer working with your family? *
Please tell us what you liked about your previous Childcare Specialist /Nanny:
Please tell us what you disliked about your previous Childcare Specialist / Nanny?
If you have any dietary restrictions in your household, please explain:
Do you have pets?

YesNo
If yes, what kind of pets? (e.g. dogs, cats, etc.)
Type a question
Work Schedule

Monday - FridayCustom Schedule
Number of days per week:
Please select the days:

SundayMondayTuesdayWednesdayThursdayFridaySaturday
Sunday Start Time & End Time

Hour Minutes

AM/PM Option

until
Hour Minutes

AM/PM Option
Monday Start Time & End Time

Hour Minutes

AM/PM Option

until
Hour Minutes

AM/PM Option
Tuesday Start Time & End Time

Hour Minutes

AM/PM Option

until
Hour Minutes

AM/PM Option
Wednesday Start Time & End Time

Hour Minutes

AM/PM Option

until
Hour Minutes

AM/PM Option
Thursday Start Time & End Time

Hour Minutes

AM/PM Option

until
Hour Minutes

AM/PM Option
Friday Start Time & End Time

Hour Minutes

AM/PM Option

until
Hour Minutes

AM/PM Option
Saturday Start Time & End Time

Hour Minutes

AM/PM Option

until
Hour Minutes

AM/PM Option
Please provide any additional information
Hourly Rate: blanks To be decidedblank (please indicate yes, if this applies)
Please tell us how you heard about Dream Childcare and Newborn CareSpecialist Staffing Agency, LLC:

Our WebsiteGoogleFriendI am a past/present ClientOther
Please provide us with the name of the source:
Signature*

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CHILDCARE SPECIALIST APPLICATION FORM

Thank you for your interest in Dream Childcare and Newborn Care Staffing Agency LLC's placement services. Before any placements or interviews a $200 Registration/Application fee is required.