Caregiver Application Form

Caregiver 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 *

Are you at least 21 years of age? *

Job position *

Which position are you applying for?

EXPERIENCES

Please tell us about your childcare experience. *

Do you have 1 year or more of infant care experience? *

What level of education do you have? *

Do you have experience working with children with special needs? *

Do you speak other languages? *

Other Languages

LOGISTICS

Do you have a car? (This is not required for the job) *

Do you have a valid driver's license? *

Are you comfortable working in a home with pets? *

SCHEDULE AVAILABILITY

Are you available to work in the daytime? *

Are you available to work in the evenings? *

REFERENCES

Please provide three professional childcare references.

Note: We will only contact your references after your interview and with your permission. If you don’t have the details available at this time, you may provide them later in the process; however, submitting them upfront helps us to expedite the process.

Childcare References

Reference #1

Reference full name

Full address

Reference phone

Reference email

Years known

Under what circumstances do you know this individual?

Were you referred by someone?

Is there anything else you would like to mention regarding your application?

Upload Resume