TLC Domestic Agency Application

Profile Pic

Please upload a profile picture.

First name *

Please provide your first name.

Last name *

Please provide your last name.

Today's Date *

Email *

Please provide your email address.

Phone *

Please provide your phone number.

Street address *

City *

State *

Zip / Postal Code *

Job position *

Which position are you applying for?

Employment type *

Live In Live Out Full Time Part Time

How did you hear about us? *

Do you have access to a vehicle? *

Make:

Model:

Year:

Color:

Do you have auto insurance as required by California law?

Are you willing to drive this car for work?

Do you have a valid driver’s license?

State Issued:

Which languages do you speak?

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

Would you be willing to cook for the family? *

Can you follow a recipe? *

When are you ready to start? *

Do you feel comfortable working with pets? *

Is there anything you definitely don’t want to do in a home? *

If so, please list:

Do you have experience working with special needs? *

If so, please list type of special needs.

Do you have experience taking care of infants?

Do you have computer skills? *

Do you have CPR Certification? *

Are you Trustline registered?

If so, please provide Trustline ID number.

Can you swim?

Level of education? *

Hobbies/Interests *

Skills? *

Briefly, tell us about yourself.

Why do you want to do this type of work? *

Hourly Rate? *

Are you looking for temporary or permanent work? *

Describe your ideal job: *

Preferred Schedule *

Please tell us your preferred week schedule.

Job History *

Add your work history below. Click + to add more entries.

Job #1

Employer Name

Your Position

Start Date

End Date

Employer Phone

Employer Email

City

State

Job Description

References *

Add your work references below. Click + to add more entries.

Reference #1

Reference full name

Full address

Reference phone

Reference email

Years known

Under what circumstances do you know this individual?

Upload CPR and First Aid Certification

Upload TB Test

Upload T-DAP

Upload DMV

Anything else you would like us to know?