While You're Out, LLC :: Babysitting Referral Service

Personal Information

Name

Street Address

City

State

Zip

Home Phone

Cell Phone

Emergency Contact

Phone

Relationship

Please provide information for the hours which you are available for work. Please be specific as to what hours you are available to work

Saturday

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

If you are a student, what school do you attend?

Are you CPR or First Aid Certified?

Can you provide documentation of your certification(s)?

Please list names and dates of certifications

Are you legally able to work in the U.S.?

If you drive and own a reliable car, what Make & Model?

If you have a valid driver’s license, what is the issueing state and license number

Social Security Number (to conduct background check)

Date of Birth

Are you comfortable around animals?

What animals would prevent you from taking a referred job at a Clients home?

Do you have any medical conditions that would impact how you perform the job?

Do you have any children of your own that you would need to bring to a Babysitting job with you? If so, how many? How often?

Can you swim?

Do you feel comfortable taking children swimming if the opportunity became available?

How many children are you comfortable handling in a six hour period?

What do you like most about working with children?

Education History

Please list most current school/institution attended first

School Name

City

State

Graduate? Diploma/Degree

School Name

City

State

Graduate? Diploma/Degree

School Name

City

State

Graduate? Diploma/Degree

Have you participated in any volunteer work that you would like us to know about?

Employment History

Please start with your most recent employer

May we contact your current employer?

Employer

Supervisor’s Name

Phone

Salary or wage per hour

Start date

End date

Reason for leaving

Employer

Supervisor’s Name

Phone

Salary or wage per hour

Start date

End date

Reason for leaving

Employer

Supervisor’s Name

Phone

Salary or wage per hour

Start date

End date

Reason for leaving

Do you have at least two years of child care experience?

Please explain your child care experience and training

Personal and Professional References

Please provide three child care related references below

Name

Company

Phone Number

Name

Company

Phone Number

Name

Company

Phone Number

Please provide at least two personal references that are not related to you below

Name

Phone #

Relationship

Name

Phone #

Relationship

Name

Phone #

Relationship

Signature

By checking this box, you agree that the information provided here is accurate to the best of your knowledge.

Disclaimer: The babysitters affiliated with While You're Out, LLC are employed solely by the client and are not employees of While You're Out, LLC.