Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What Type of Position would you like?
*
Full-time Babysitter
Part-Time Babysitter
Live Out Nanny
Live In Nanny
EXPERIENCES
Please tell us about your childcare experience.
*
Do you have 1 year or more of infant care experience?
*
Yes
No
What level of education do you have?
*
High School
Some College
Bachelors Degree
Masters Degree
PhD
Teaching Qualification
Do you have experience working with children with special needs?
*
Yes
No
Do you speak other languages?
*
Yes
No
Other Languages
LOGISTICS
A car is not required, but we would like to know if you have one.
Do you have a car?
*
Yes
No
Do you have a valid driver's license?
*
Yes
No
Are you comfortable working in a home with pets?
*
Yes
No
SCHEDULE AVAILABILITY
Are you available to work in the daytime?
*
Yes
No
Are you available to work in the evenings?
*
Yes
No
REFERENCES
Please provide 3 references
References Name
*
E-mail
*
example@example.com
Phone Number
*
Reference’s relationship to you
*
How long were you at this position?
*
Please describe the circumstances under which this person has observed you with children:
*
References Name
*
E-mail
*
example@example.com
Phone Number
*
Reference’s relationship to you
*
How long were you at this position?
*
Please describe the circumstances under which this person has observed you with children:
*
References Name
*
E-mail
*
example@example.com
Phone Number
*
Reference’s relationship to you
*
How long were you at this position?
*
Please describe the circumstances under which this person has observed you with children:
*
ADDITIONAL INFORMATION
Were you referred by someone?
Is there anything else you would like to mention regarding your application?
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