Caregiver Application
Complete this form and Let me do that! for you. The information you provide will be held
confidential.
Your Name:
E-mail Address:
Home Phone:
Cell Phone:
Work Phone:
Island Phone:
Home Address Street:
Street:
City, State and Zip:
Island Address - Mailing:
Island Address - Physical:
Do you have a legal right
to work in the United
States? How old are you?


Have you been convicted
of a crime?  If yes,
Provide details.
Education:
High School Name
Did you graduate?
Date



College Name/Degree
Did you graduate?
Date



College Name/Degree
Did you graduate?
Date



List Additional Training or
certifications:
Please let us know the first
and the last date you are
available for an assignment.


Choose the days of the
week and times of day you
are available for an
assignment.

Hold Down Ctrl Key to
Select Multiple Options
#1 Childcare reference
contact name/contact
telephone and email,
number of children and
ages & dates of service.
Can we check this
reference?
#2 Childcare reference
contact name/contact
telephone and email,
number of children and
ages& dates of service.
Can we check this
reference?
#3 Childcare reference
contact name/contact
telephone and email,
number of children and
ages & dates of service.
Can we check this
reference?
#4 Work (not childcare)
reference contact
name/contact telephone
and email, work performed
& dates of service. Can we
check this reference?
Areas of Expertise:
Hold Down Ctrl Key to
Select Multiple Options
Describe your
qualifications, real
experiences & desired rate
of pay.
How do you discipline?
Toddlers
Preschool
Elementary
Pre-teen
Teen
Do you have your own
reliable transportation?

Will you drive your own
vehicle to assignments?

Describe your driving
record.
Please tell us about your
interests and the activities
you like to do with children.
Please tell us about your
best, worst and
most difficult childcare
experiences.
Do  you swim?
Do you Smoke?
Will you accept an
assignment if there are
pets in the house?
Please provide any
additional information you
feel will assist us in
providing the Let Me Do
That! Caregiver that will
best meet your needs.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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