Join Our Team

Contact Information

Choose your primary location:

Demographic Info
First Name				Last Name
Local Address
City				State ZIP
Permanent Address
City				State ZIP
Cell Phone				Home Phone
Email (Login ID)
Birth Date
Sex			Female Male
Marital Status			Single Married Divorced Separated
I am legally eligible to work in the U.S.			Yes No
I have children of my own			Yes	Ages of my children
I have a car to get to work with insurance and a valid driver's license			Yes No
I have been arrested or charged with a misdemeanor or felony			Yes No	Details
I have had a moving or driving related violation or traffic accident (including tickets)			Yes No	Details
Have you ever been the subject of a substantiated complaint of child or sexual abuse?			Yes No
I graduated from High School			Yes No
			HS Name
			HS City/State
			Year Graduated
I received a GED			Yes	Date earned
College Undergrad Information
None Some Current
			College Name
			Month/Year Started
			Major
			Minor
Graduate
			College Name
			Month/Year Graduated
			Major
			Minor
Graduate School
			College Name
			Month/Year Graduated (or expected)
			Major
			Minor
Health Information
Allergies			Yes No	Details
Any medications taken regularly			Yes No	Details
I am a smoker			Yes No
Specify any other health concerns

Work History
Currently Employed Full-time Part-Time Unemployed
Please list your past 4 employers including Nanny positions, babysitting positions, or other jobs.
Employer FT/PT Start Date End Date Position Reason for leaving




How many years of childcare experience do you have?
How many children are you comfortable caring for at one time?
I have experience AND feel comfortable with:
	Working as a Nanny			Yes No
	Changing diapers			Yes No
	Potty Training			Yes No
	Child Sleep Training			Yes No
	Multiples			Yes No
	Newborns			Yes No
	Newborn Multiples			Yes No
	Helping a child cope with divorce			Yes No
	Bathing a baby / child			Yes No
	Caring for ill children			Yes No
	Caring for a nursing baby			Yes No
	Giving medications to children			Yes No
	Child-proofing a home			Yes No
	Helping a child cope with death			Yes No
	Special Needs			Yes No
Please select the special needs with which you have experience:
Anxiety		Asperger's syndrome			Asthma
Attachment disorder		ADD / ADHD			Autism / Autism Spectrum
Behavioral difficulties		Bipolar disorder			Blindness
Central Auditory Processing Disorder		Cerebral Palsy			Cystic Fibrosis
Deaf		Depression			Diabetes
Down Syndrome		Dwarfism			Eating Disorders
Epilepsy		Food Allergies			Mental Retardation
Muscular Dystrophy		Obesity			Obsessive Compulsive Disorder
Oppositional Defiant Disorder		Panic Disorder			Seizures
Self-Esteem Problems		Terminal Illness

Please select the ages with which you have experience:
Premie - 3 months		3 - 12 months			1 - 2 years
3 - 5 years		6 - 8 years			9 - 12 years
13 - 17 years		18 years and up

Additional tasks you are comfortable performing:
Light Houskeeping		Heavy Housekeeping			Family Laundry
Carpooling		Meal Preparation			Meal Cleanup
Dusting		Ironing			Vacuuming
Cleaning Bathrooms		Pet Care			Walking the Dog
Errands		Grocery Shopping

Please select the family situations in which you would like to work:
At-home Mom		At-home Dad			Single Mom
Single Dad		Two working parents

Other Experience:
I can swim			Yes No
I enjoy being outside			Yes No
I enjoy playing sports with children			Yes No
I enjoy art projects with children			Yes No
I would travel with families			Yes No
I am willing to do overnight placements			Yes No

Elderly Care:
I have experience with Elderly Care			Yes No
I would like to help care for elderly clients			Yes No
If yes, I would like to help in the following ways:
Grocery Shopping		Light Housekeeping			Heavy Housekeeping
Laundry		Cooking			Feeding Pets
Driving to appointments		Running Errands			Sitting with elderly while primary caregiver is out
Entertaining / spend time with elderly		Live-in as primary caregiver

I have experience Tutoring Children			Yes No
I would like to be a tutor			Yes No
If yes, I comfortable tutoring the follownig ages / subjects:
Pre-school
Reading/letter recognition/sound recognition		Math/number awareness/shapes			Colors
Kindergarten - 3rd grade
Reading		Math			Science
Language Arts		Social Studies
4th - 9th grade
Math		Science			Language Arts
Social Studies
10th - 12th grade
Math		Science			Language Arts
Social Studies		SAT / ACT prep
Lessons
Piano		Guitar			Cheerleading
Soccer		Swimming			Flute
Clarinet		Saxophone
Other Instruments
Other Sports

Please explain why you want to join The Sitter Connection
Being reliable, trustworthy, responsible, and having great communication is very important to the The Sitter Connection families. Please describe how you are reliable, trustworthy, responsible, and communicate well:
Please describe your experience caring for children:
Describe any special skills/certifications/degrees you have that you feel would make you a valuable asset to The Sitter Connection:

I have the following certifications: (You will need to provide certification cards)
CPR		FirstAid			Teaching

I would like to be a nanny				Yes No
I can make a 1-year commitment to a family				Yes No
	Live-In			Live-Out
	Full-Time			Part-Time

Petsitting:
I have experience pet sitting				Yes No
I would like to pet sit				Yes No
Dogs		Cats			Birds
Other Animals

Self Assessment
On a scale of 1 to 10 (10 being highest), please rate the following as honestly as possible:
Ability to be a self-starter
Sense of humor
Patience
Common sense
Ability to make friends
Control my temper
Ability to follow directions
Honesty
Neatness
Maturity
Ability to speak up when something bothers you


Work References
Please list 3 individuals who have hired you as a nanny, babysitter, tutor, camp counselor, teacher, child care provider, volunteer worker with children or Elder care provider and whom we may contact as references. These should be different than your personal references above
Name Job Performed Phone Number Email Address




Friends
Please list any sitters/nannies/care providers that already work for us and tell us how you know them
Name Relationship






Sitter Release Form
This is an agreement between the sitter, whose information appears above, and The Sitter Connection, Ltd. By clicking the box following this agreement and submitting my information, I hereby represent and agree that the relationship between myself and The Sitter Connection, Ltd. is that of independent contractor, and no agency relationship has been or will be created between us. I agree to indemnify and hold harmless The Sitter Connection, Ltd. against any and all damages, claims, actions, costs and expenses, including attorney's fees, asserted by any person and arising out of or otherwise relating to the rendering of, or failure to render, any service by The Sitter Connection, Ltd. or myself. I further agree that for a period of one year following the termination of the agreement with The Sitter Connection, Ltd. for any reason, I will not work for any client of The Sitter Connection, Ltd. unless first obtaining the consent of The Sitter Connection, Ltd. and agreeing to work for such client only in full compliance with the procedures and requirements of the sitter agreement of The Sitter Connection, Ltd. then in use.
I agree to the preceding Sitter Release Form: