Baby Sitters Across America

Babysitter Application Form

YOU MUST FILL OUT THIS APPLICATION OUT COMPLETELY FAILURE TO DO SO MAY RESULT IN A DELAY IN PROCESSING! USE N/A FOR AREAS NOT APPLICABLE.

1. SPELLING AND PUNCTUATION ARE ESSENTIAL! DOUBLE CHECK FOR ERRORS OR THIS MAY CAUSE A DELAY IN PROCESSING. WE CANNOT PRESENT APPLICATIONS WITH ERRORS TO OUR CLIENTS!
2. Please be as thorough as possible in each section.
3. Make sure you have all phone numbers for references available because this is very important to include in your application.
4. When filling in your answers in a text box, DO NOT hit your 'Enter' or 'Return' keys.
5. Your Name and Email Address are required fields.
6. Please click on the 'Submit' button only once.
7. Make sure that you mail us a recent photo of yourself with your application if you are out of state.. If you are in state, a personal interview is required before your application process is complete.
8. Our address is Babysitters Across America, LLC P.0. Box 3097, Boulder, Colorado 80307.

FILL OUT THIS APPLICATION COMPLETELY!
Use N/A in areas that do not apply to you.

General Information

Today's Date:	Position applying for:
First Name:	Last Name:

Nickname:
Present Address:
City:
State:
Zip:

Home Phone:
Work Phone:
Cell Phone:
Email Address:

Date of birth: (mm.dd.yy)

Social Security #

In case of an emergency, please notify (Name and phone #):
How did you hear about Babysitters Across America?
What states have you lived in the last three years?

I am legally eligible to work in the United States:	Yes No
Have you ever applied to Babysitters Across America before?	Yes No
Are you, or have you ever been registered or placed with another babysitter agency?	Yes No

If yes, give date:	If registered, list agencies and dates:

Position Desired: (Please Check all that Apply)

Full Time Babysitter	House Manager	Housekeeper	Live In	Live Out
Part Time Babysitter	Temporary/On Call	Summer Babysitter	Personal Assistant

Geographic areas preferred:

Hours and days you're available to work:

Monday:	Start:	Finish:
Tuesday:	Start:	Finish:
Wednesday:	Start:	Finish:
Thursday:	Start:	Finish:
Friday:	Start:	Finish:
Saturday:	Start:	Finish:
Sunday:	Start:	Finish:
Holidays:	Start:	Finish:

Date you could begin work:

Can you commit for 1 year? If not, for how long and why?:

Would you consider staying longer than one year? Yes No

Please describe your type of lifestyle:

Maximum number of children, you are willing to care for?
What ages of children do you prefer to work with?

I am experienced with children of the following ages (Check all that apply):

Newborn to 9 months	9 months to 24 months	2 to 5 years
5 to 10 years	older than 10 years	Special Needs/Disabled

Tell us about yourself:
Describe your personality:
Please list any skills or talents you have in Music, Art, Athletics, Technology, Education, Nutrition, Cooking, Foreign Languages etc.
What are your hobbies and personal interests?

Do You Smoke?	Yes No	Are you willing to work with a family that smokes?	Yes No
Will you work evenings?	Yes No	Will you work weekends?	Yes No
Do you have visible tattoos?	Yes No	Do you have any face piercings ?	Yes No

Are you:

Infant/Child First Aid trained?	If yes, please list expiration date:
Certified Life Guard?	If yes, please list expiration date:

If you are not certified currently, do you agree to become certified for CPR, and 1st aid within 30 days?

Are you experienced and willing to help with the following household chores, should they become part of your job description?

General Housekeeping	Laundry	Ironing
Grocery Shopping	Running Errands	Prepare Simple Family Meals

Do you have children that live with you?	Yes No
Do you have a valid driver's license:	Yes No
Has your license ever been revoked or suspended?	Yes No

If Yes, please explain:

Driver's License #	Make/Year/Model of car:
State Issued:	License Plate/s
Date of Expiration:

Have you ever been charged and/or convicted of a DUI or DWI?	Yes No
Have you ever been arrested?	Yes No
Have you ever been convicted of a misdemeanor or a Felony?	Yes No

If so please explain?

Please list information on your childcare references

From:

Family or Organization:

To:

Address:

Length of Time/Frequency:

Home Phone:

Age of Children?

Work Phone:

From:

Family or Organization:

To:

Address:

Length of Time/Frequency:

Home Phone:

Age of Children?

Work Phone:

From:

Family or Organization:

To:

Address:

Length of Time/Frequency:

Home Phone:

Age of Children?

Work Phone:

If employing family requests, would you submit to: (Check all that apply)

Physical Examination

Yes No

T.B Test

Yes No

Drug Screening

Yes No

Other Background Checks

Yes No

What qualities do you think are important in a babysitter?
What do you see as your personality strengths?
What kinds of activities do you like to do with children?

Education

	School Name:	School and Location	Date Graduated	Degree
HIGH:
COLLEGE:
OTHER:

Major(s) Studied	List any extra-curricular activities in school and/or college

Are you currently attending school?

Yes No

If you are currently attending college or work part time what is your availability?

How will your schedule change within the next year?

Please list any child care classes/seminars you have completed:

Personal References

Please list your references below: Please note if they are relatives or list any person twice (duplicate).

Name	Relationship To You	Phone (home and work)

Name 2	Relationship To You 2	Phone2 (home and work)

How did you hear about Babysitters Across America? If referred by someone directly, please list names
Tell us your salary range
Per hour to start

Tell us about any other child care experience you have (childcare centers, camps, etc...).

I certify that the information provided by me in this application (and accompanying resume, if any) is true and complete. I authorize Babysitters Across America, LLC or its representatives to investigate all statements contained in this application. I understand that any false information, omissions or misrepresentations of facts may result in rejection of my application. I authorize any person, school, current employer (unless otherwise noted in this application form), past employer(s), and organizations named in this application form (and accompanying resume, if any) and any other person or entity with knowledge of me to provide Babysitters Across America, LLC with any information and opinion which Babysitters Across America, LLC regards as useful in making a referral decision. I release such persons and organizations from any legal liability in making such statements, or furnishing any and all information which the agency may seek. I understand that I will not have access to the confidential information received, however. I agree to relieve Babysitters Across America, LLC of any liability or consequences which might result from obtaining said information from others.

I have read and agree to the Privacy Policy (Opens in a new window)

Date:

Signature:

This application form is detailed for use in evaluating your suitability to be referred by our agency to our clients. It is not an application employment contract. Once your application is reviewed and accepted by our agency, a personal interview ( in state only) and necessary background / reference checks will need to be completed for us to begin the process of matching you with the family that best matches your needs!

Please note that clicking on the 'Submit' button is your confirmation that all of the information you are submitting is true and complete. I certify that I am the person submitting this application.

Please click on the 'Submit' button only once.