General Information:

Employment History

Please describe your child care experience:

Ideally, what age children would you prefer to work with? You can select more than one.
Infants
Toddlers
School age
Any age

How many children would you like to care for?
One
Two
Any number

Would you feel comfortable caring for an infant (under 6 months)?
Yes No

Do you have infant experience?
Yes No

Briefly describe how you would spend a day caring for children:

What method of discipline do you feel is most effective and why?

What method of discipline do you feel is least effective and why?

How would you handle an emergency?

What are your goals for the next two years?

What do you consider your strengths?

What do you consider your weaknesses?

For Live-in Positions

Have you ever lived independently of your family?
Yes No

Do you have siblings? Yes No
If yes, specify their ages:

References

Please provide 3 references. One personal, 1 job/child care related, and 1 school (if applicable)

Reference 1 - Personal

Name

Name

Name

Agreement and Certification:

I certify that the above information is true and complete.

I agree to having Family Helpers, Inc. ("FHI") or their authorized agents investigate any of the above information. I further agree to fully cooperate with those efforts including the provision of additional information and required releases.

I understand that by accepting this application from me, FHI makes no guarantee of employment.

FHI assumes no liability or responsibility to confirm or verify all information supplied to it by any employer or potential employer. I agree to hold FHI harmless from any act, failures to act, or omissions by any employer or potential employer, referred to me, or to whom I am referred, by FHI.

I agree to notify FHI within 7 days of receiving an offer of employment by any such party, and should such party then fail to pay FHI its usual fee, then I agree to pay FHI the maximum fee allowed by New York State General Business Law Article !! Section 185.

This agreement shall be binding only upon the parties hereto and shall not include any third party. FHI shall not be a party to any agreement entered into between Applicant and any employer or potential employer.

Yes No