Candidate Application Form

First name *

Please provide your first name.

Last name *

Please provide your last name.

Email *

Please provide your email address.

Phone *

Please provide your phone number.

Street address *

City *

State *

Zip / Postal Code *

I am interested in the following job types: *

How did you hear about us? *

Which locations are you interested in? *

Charleston SC (Surrounding Areas) Seattle/ Bellevue WA (Surrounding Areas) West Palm Beach FL (Surrounding Areas)

Are you at least 18 years old? *

Are you legally authorized to work in the USA? *

Have you ever been convicted of a felony? *

How many hours are you seeking to work per week? *

How long can you commit?

Date available to begin. *

Desired rate per hour *

Time Availability

Please tell us your preferred week schedule.

Are you a smoker? *

Vaccinations *

Covid-19 Flu shot tDap

Highest Level of Education Completed *

High School Diploma Some College Bachelor’s Degree Master’s Degree I am currently enrolled Other

Experience Overview

Have you ever been hired in the role you are seeking? *

Experience: Ages of Children cared for *

Newborn-3m 3m-12m 12m-2yrs 2yrs-4yrs 5yrs and up N/A

Years of paid experience from age 18 and on for the position you seek? *

0-2 years 3-6 years 6-10 years 10+ years

How many children are you comfortable caring for at one time? *

Abilities:

Swim Children with Special Needs Languages fluent in other than English

Certifications

CPR First Aid Newborn Care Specialist Newborn Care Specialist (Certified) Sleep Training Doula Culinary Arts Pet Care Other

If Doula, select which type

Birth Postpartum

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?

If you were referred, please share who referred you:

Please upload your resume

If you have one.

Summary

I am aware that if I am placed with a family, I will be obligated to keep their personal and professional integrity confidential and private. Understanding, some family will require a Nondisclosure Agree to be signed as part of the contract. *

I agree I certify that all answers given on this application are true and complete to the best of my knowledge. Please initial the box.

Initials *