Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How far are you willing to travel?
*
Please list all languages you speak fluently.
*
Preferred Start Date
*
MM
DD
YYYY
Minimum AND maximum hours per week?
*
Beyond childcare, are there any additional tasks that you are willing to perform?
*
Please note that anything regarding house management (laundry, cooking, cleaning) typically increases the pay rate.
Do you have a valid driver's license?
*
Yes
No
Are you comfortable driving? Do you have your own car?
*
Yes, comfortable driving
No, not comfortable driving
Yes, I have my own car
No, I do not have my own car
Will your caregiver be required to drive?
*
Yes
No 2
Are you comfortable with pets in the home?
*
Yes
No
Are you up to date on all your vaccinations (COVID, TDap, MMR, Hep A&B, Flu, etc.)?
*
Please list 2-3 references (full names, email and/or mobile #)
*
How long are you hoping to stay at your future position?
*
Please describe your ideal family.
*
