Kiddie Care

Sitters Registration Form

Basic Information

1. First name :
2. Surname * :
3. Date of birth :
4. Gender : Male Female
5. Email *:
6. Primary number :
7. Alternate number :
8. Permanent address :
9. City :
10. State :
11. Zip code :

Employment Specification

1. Days available:
2. Hours available:
3. Rate:
4. Area of coverage:
5. Ages comfortable with: 0-1 1-3 3-10 10+
6. Maximum number of children:
7. Do you drive?
8. Do you own your own transportation?
9. Are you willing to travel?

About You

1. Education level:
2. Major:
3. Degree completion date:
4. Do you smoke?
5. Do you have allergies?
6. Capabilities: Cooking Driving Laundry Light housekeeping Run Errands
7. Skill certification: Behavioral Issues Special Needs CPR First Aid
8. Hobbies/Interest:

Employment Criteria

1. Do you have a police record? Yes No
2. Will you consent to a Drug Test? Yes No
3. Are you legally allowed to work in the US? Yes No
4. * Child experience:
   
5. * Are you human? : 2 + 3 =

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