Sitter Submission Form

CAREGIVER APPLICATION

We are always looking to add experienced, professional, caring, and fun providers who make safety the number one priority. If this sounds like you, please fill out an application!
Full Name*

First NameMiddle NameLast Name
Email Address*
Cell phone*

Area CodePhone Number
Home phone

Area CodePhone Number
Date of birth*

MonthDayYear
Social security number*
Valid Driver’s License number*
Upload photo of Driver’s License

Upload a File

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Have you ever legally been known by another name?*

NoYes
OTHER names you’ve legally been known as:*
Current Physical Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Do you receive mail here?*

NoYes
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Length of residency on Kauai*
Have you resided in any other states in the last 10 years?*

NoYes
Please list the states*
Have you ever been convicted of a felony?*

NoYes
Have you ever been ACCUSED of mistreating a child?*

NoYes
Have you ever been ACCUSED of any sex crimes?*

NoYes
If yes to any of the last three questions, please specify*
Available to start

MonthDayYear
EMPLOYMENT
CURRENT job title*
May or may not be non-childcare related
Start Date*

MonthDayYear
Date
Are you still working with them? If not, when and why did you leave?
Scope of duties + responsibilities
Supervisor*

First NameLast Name
Supervisor’s Email*
example@example.com
Supervisor’s phone no.*

Area CodePhone Number
Your last CHILDCARE RELATED job:*
childcare
Start Date*

MonthDayYear
Date
Scope of duty + responsibilities:
Supervisor*

First NameLast Name
Supervisor’s Email*
example@example.com
Supervisor’s phone no.*

Area CodePhone Number
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Why did you leave?
Another childcare related job*
Supervisor*

First NameLast Name
Start Date

MonthDayYear
Date
Supervisor’s Email*
example@example.com
Supervisor’s phone no.*

Area CodePhone Number
Scope of duty + responsibilities
End Date

MonthDayYear
Date
Why did you leave?
EXPERIENCE & KNOWLEDGE
Please explain any additonal professional and casual experience caring for children (include all ages):*
When did you know you liked working with kids?*
Do you have children of your own? How many and what ages?*
Describe age appropriate activities appropriate for each group:
6 months-walking
Walking to 3 years old
3-5 year olds
School aged children
How do you soothe a crying infant/toddler? *
How will you deal with an unruly/unsafe child? *
What steps would you take in an emergency?*
Do you have any special certificates or qualifications such a speaking other languages?*
Are you:

A non-smokerOver 18 years oldvaccinated and/or boostered against COVIDobservant of general health practices
Are you adult & infant CPR/First Aid certified?*

CURRENTLY certifiedNo, though I am renewing my certificate.No, though I am willing to become certified.No, I am NOT willing to become certified.
Upload valid CPR/First Aid certification

Upload a File

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Do you have any physical, medical or mental conditions that may limit your ability to safely and effectively perform childcare? *
Having a potential limitation is not an automatic disqualifier.
Please share more about your limitations:*
Include if your limitations are due to challenges with mobility, vision, mental, hearing, fatigue, chronic pain, etc, and how you manage them. We do our best to celebrate human diversity, while ensuring safety of the children and the caregiver are the number one priority.
PROFESSIONALISM
“On-Time” means:
Please select your most closely related practice.
Your phone dies/gets run over/goes for a swim on your way to a job. What do you do?*
How would you describe yourself as a sitter?*
What do you think someone would say is your biggest area of growth, [1] personally and [2] professionally?*
Transparency is HIGHLY valued here. We are here to promote growth!
The sit didn’t go so well. You can tell the parents are unhappy. What do you do?*
What are your best record keeping practices?*
With so many moving parts to our various professional and personal schedules, what do you do to ensure accountability for your bookings and appointments?
Do you receiving babysitting work any other way?

I don’tAnother agencyWord of mouthOnline sourcesFriendsConciergeOther
Why do you choose KBC?*
There are various on-island agencies who operate in a similar capacity as KBC.
What are you looking for in Kauai Babysitting Co. as an agency? *
Kauai Babysitting Co. works FOR the sitters and their interests.
What do you think you would bring by being added to the Kauai Babysitting Co team?*
Do you receiving babysitting work any other way?

I don’tAnother agencyWord of mouthOnline sourcesFriendsConciergeOther
Do you have your own General Excise Tax ID #?*

Yes.No, but I AM willing to apply for one.No, I am NOT willing to apply for one.
Having your GE opens new doors for your business. If you need a GE Tax ID please click here, then hit “Get Started”–follow the directions. It only takes about 10-15 minutes and $20!
Upload GE Tax ID

Upload a File

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Do you have:

Reliable transportation3+ years of professional childcare experienceIntentions to be on island for 6+ months
REFERENCES

CHILDCARE related
Professional Reference:*

First NameLast Name
Phone Number*

Area CodePhone Number
Professional Reference:*

First NameLast Name
Phone Number*

Area CodePhone Number
Upload a photo of yourself

Upload a File

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Kauai Babysitting Company is a REFERRAL service that only refers top-notch childcare providers to clients. Babysitters are not employees and are required to carry their own insurance, as well as reporting their income to the proper agencies. We are dedicated to a policy of non-discrimination on any basis including race, creed, color, age, sex, religion, or national origin.

"By signing and submitting this application, I agree to the conditions and requirements as outlined in this document. I authorize investigation of all statements contained in this application. I understand that misrepresentation of omission of facts is grounds for dismissal."
Signature*
Should be Empty:

CAREGIVER APPLICATION

EMPLOYMENT

EXPERIENCE & KNOWLEDGE

Describe age appropriate activities appropriate for each group:

PROFESSIONALISM

REFERENCES