Sitter Application

 

Looking for a sitter job?

Provide us with the following information and we'll get in touch with you ASAP.

 

Name:

 

Address:

City:

Zip Code:

 

Phone:

Mobile:

E-Mail:

 

Emergengy Contact:

 

Name:

Relationship:

Phone:

 

Please provide information for the hours, which you are available for work. Please be specific as to what hours you are available to work:

 

Saturday:

From:

To:

 

Sunday:

From:

To:

 

Monday:

From:

To:

 

Tuesday:

From:

To:

 

Wednesday:

From:

To:

 

Thursday:

From:

To:

 

Friday:

From:

To:

 

If you are a student, what school do you attend?

 

Are you CPR or First Aid Certified?

Yes  No

 

Can you provide documentation of your certification(s)?

Yes  No

 

Please list names and dates of certifications:

 

Are you legally able to work in the U.S.?

Yes  No

 

If you drive and own a reliable car, what Make & Model?

Make:   Model:

 

If you have a valid driver’s license, what is the issuing state and license number:
State:   Number:

 

Social Security Number (to conduct background check):

 

Date of Birth:

Month:   Day:   Year:

 

Are you comfortable around animals?

Yes  No

 

What animals would prevent you from taking a referred job at a Clients home?

 

Do you have any medical conditions that would impact how you perform the job?

 

Can you swim?

Yes  No

 

Do you feel comfortable taking children swimming if the opportunity became available?

Yes  No

 

How many children are you comfortable handling in a six hour period?

 

What do you like most about working with children?

 

Education History
Please list most current school/institution attended first:

 

School Name:

 

City:

State:

 

Graduated?

Yes  No

 

Diploma / Dreegree:

 

School Name:

 

City:

State:

 

Graduated?

Yes  No

 

Diploma / Dreegree:

 

Have you participated in any volunteer work that you would like us to know about?

Yes  No

 

If Yes, tell us about it:

 

Employment History
Please start with your most recent employer:

 

Last Employer:

Employer:

Supervisor's Name:

 

Phone:

Salary or wage per hour:

 

Start Date:

End Date:

 

Reason for Leaving:

 

2nd to Last Employer:

Employer:

Supervisor's Name:

 

Phone:

Salary or wage per hour:

 

Start Date:

End Date:

 

Reason for Leaving:

 

3rd to Last Employer:

Employer:

Supervisor's Name:

 

Phone:

Salary or wage per hour:

 

Start Date:

End Date:

 

Reason for Leaving:

 

Do you have at least two years of child care experience?

Yes  No

 

Please explain your child care experience and training:

 

Personal and Professional References
Please provide three child care related referentes below:

Name:

Relationship:

Phone:

 

Name:

Relationship:

Phone:

 

Name:

Relationship:

Phone:

 

By checking this box, you agree that the information provided here is accurate to the best of your knowledge.

 

 

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