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Your Name:
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E-mail Address:
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Home Phone:
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Cell Phone:
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Work Phone:
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Island Phone:
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Home Address Street:
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Island Address - Mailing:
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Island Address - Physical:
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Do you have a legal right to work in the United States? How old are you?
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Have you been convicted of a crime? If yes,
Provide details.
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Education:
Did you graduate High
School? Date & Name
Did you graduate College?
Date & Name/Degree
Did you graduate from an
Additional College? Date &
Name/Degree
List Additional Training or
certifications:
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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
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#1 Reference contact name
Contact Telephone & Email
Number of children, ages,
dates of service & wage
Can we check Reference #1?
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#2 Reference contact name
Contact Telephone & Email
Number of children, ages,
dates of service & wage
Can we check Reference #2?
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#3 Reference Contact Name
Contact Telephone & Email
Number of children, ages,
dates of service & wage
Can we check Reference #3?
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#4 Work (not childcare)
Reference Contact Name
Contact Telephone & Email
Work Performed, date &
wage
Can we check Reference #4?
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Areas of Expertise: Press & hold
Ctrl Key to Select Multiple Options
Describe your qualifications,
real experiences & desired
rate of pay.
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How do you discipline?
Toddlers
Preschool
Elementary
Pre-teen
Teen
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Do you have your own
reliable transportation? Will
you drive your own vehicle
to assignments? Describe
your driving record.
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Please tell us about your
interests and the activities
you like to do with children.
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Please tell us about your
best, worst and most difficult
childcare experiences.
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Do you swim?
Do you Smoke?
Will you accept assignments
if there are pets?
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Please provide any additional
information you feel will assist
us in matching you with
Families.
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Caregiver and Agency Agreement/Understanding
All Caregiver information submitted through this web site will be held confidential and will be shared with Families who have Family Applications on
file with Let me do that!:
1. Let me do that! agrees to make its best effort to locate Families with temporary child assignments for Caregiver on an as requested basis.
2. Caregiver recieves payment from Family for services rendered and a transportation fee of $12.00 per assignment unless waived by Caregiver in
writing.
3. Caregivers understand that assignments with Families originally introduced to Caregiver by Let me do that! must be arranged through the Let me
do that! office.
4. Caregiver agrees that he/she will not accept assignments from Families referred by Let me do that! or Assignments from Referrals of Families
referred by Let me do that! without the written consent of the Let me do that! office.
5. Caregiver further understands that acceptance of assignments from a Family referred by Let me do that! or from Referrals of Families referred by Let
me do that! without arranging the assignment through the Let me do that! office will result in a charge of $800 for liquidated damages.
6. Caregiver agrees to $800 liquidation charge.
7. Caregiver is an independent contractor and is in compliance with all local, state and federal regulations.
8. Caregiver is not an employee of Let me do that! and is responsible for insurance, withholding and other taxes.
9. Caregiver understands that he/she will receive Family Applications and their Caregiver Application will be sent to Families. Information provided
by Let me do that! about Familes should be verified by the Caregiver prior to accepting an assignment with a Family.
10. Caregiver agrees to forever indemnify, release and hold harmless Let me do that!, its agents, employees and officers for any and all claims
relating to services provided by Caregiver and Families.
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Choose Yes to indicate that you agree with items 1 to 10 above.
Type your name and today's date.
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