Northside Sitters Club Application

Application for Contract Work Northside Sitters Club Temporary Childcare Agency

Full Name*

First NameMiddle NameLast Name

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address*

Phone Number*

Area CodePhone Number

Applying for Position*

Start date

MonthDayYear

Upload Resume*

Upload a File

Why Do you want to work with Northside Sitters Club?

How did you find out about Us?

Do you Have Transportation?

Please Provide Drivers License Number

Car make and Model/Color

When would you be available to Work Days/Times?

Do you Have Children if so how Many?

Would you be able to care for newborn/infants with no Problems?

Will you be able to change a Diaper? If no Please Explain.

What age of Childern are you comforatable with?

How many childern can you handle at one time?

Do you have CPR/First AID training? Please Provide Renewal Date

Can you Apply First Aid if Necessary?

Have you ever pleaded guilty to, or been convicted of a criminal offense? If So Please Explain.

Are you a Citizen of the United States or do have a legal right to be employed the U.S?

Proof of citizenship or immigration Status will be required.

Personal Information

Do you Have Health Problems?

Have you ever had a nervous breakdown or nervous condition of any kind.

Do you have a history of Epilespy ?

Do you have any history of Heart trouble ?

Do you Smoke?

Have you ever had a Drinking problem?

Are you willing to work after 9:00pm

Employment History

Employer Name

Date of Employment

Address

Position/Title

Duties

List 3 References: Name,Address,Phone Number.

References:

Applicant Signature

Date of Application