I am interested in working:
day (9-1pm)
full day (9-4pm)
Can you commit to work from June 22nd -
August 21st?
Yes
No
If not, what is your availability and why?
Do you want to be included on the babysitting list?
Yes
No
Contact Information
Permanent Mailing Address:
Home Phone:
Cell Phone:
E-mail Address (required):
E-mail Address (reenter):
Social Security#
Are you over 18 years of age?
Yes
No
In case of emergency notify:
Name
Phone:
Criminal History
Have you ever been convicted of a crime, including
any sexual abuse or molestation infractions?
Yes
No Your Digital Signature (please type your name)*
*By typing your name you are authorizing us to conduct a background
check.
Educational and Professional Training
High School:
College:
Other school or training programs:
Professional Experience:
References
Reference #1:
Name:
Organization:
Relation to Applicant:
Email:
Phone:
Reference #2:
Name:
Organization:
Relation to Applicant:
Email:
Phone:
Reference #3:
Name:
Organization:
Relation to Applicant:
Email:
Phone:
By submitting this application electronically,
you agree that we can verify any or all information contained
on this application.
Pressing "Submit" below indicates
your acceptance of these terms, and consitutes your irrevocable
digital signature.