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AMP Placement
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DC (DMV)
Richmond
Tidewater
Ohio
Georgia
Pricing
Temporary Pricing
DC (DMV)
Ohio
Tidewater
Richmond
Georgia
Permanent Pricing
DC (DMV)
Ohio
Tidewater
Richmond
Georgia
Payment
Contact
Login
Blog
Menu
Who We Are
Our Mission
Our Nannies
What We Do
Our Services
Sitterworx
Our Process
Locations
DC (DMV)
Richmond
Tidewater
Ohio
Georgia
Pricing
Temporary Pricing
DC (DMV)
Ohio
Tidewater
Richmond
Georgia
Permanent Pricing
DC (DMV)
Ohio
Tidewater
Richmond
Georgia
Payment
Contact
Login
Blog
Candidate Questionnaire for Childcare Positions
Please complete this pre-screening form to be considered for our nanny and babysitter positions
Candidate Questionnaire
Your Info
First Name
Last Name
Which position are you interested in?
Years of Experience?
What city do you currently reside in?
What is the highest level of education you have completed?
Mobile Number
Email
Most families will only accept a vaccinated caregiver. Are you vaccinated for Covid-19 or plan to become?
Yes
No
Rather not say
Do you have a physical copy of your Social Security Card
Yes
No
Required Work Hours
Work Hours
Can you begin working at 8am?
Please Select
Yes
No
Can you work until 6pm?
Please Select
Yes
No
Tidewater Area (Hampton - Chesapeake & Surrounding Areas & Franklin, VA. & Smithfield, VA.) Only
Can you work any of these Morning times? (Check all that apply)
3 am
4 am
5 am and after
None of these
Can you work any of these evening times? (check all that apply)
3 pm
4 pm
5 pm
6 pm
None of these
Additional Questions
Can you work overnights?
Please Select
Yes
No
Occasionally
How many children will you work with at one time?
Which days are you able to work?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Do you drive your own insured vehicle?
Please Select
Yes
No
Are you currently working?
Please Select
Yes
No
How many teaching references do you have?
How many child care related references do you have?
Where do you currently work?
Where What ages have you worked with?do you currently work?
Do you need to update your CPR/1st Aid certification or is it current?
Please Select
It's Current
Need to update
Don't have one
What Languages do you speak other than English
None
Spanish
Chinese
Portugal
Other
Are you willing to travel with families?
Yes
No
Occasionally
Do you have any other certifications or degrees? If so, which ones
Let us know any other details that could affect work availability:
Are you pet friendly?
Please Select
Yes
No
Are you allergic to cats or cat hair?
Please Select
Yes
No
Will you work in homes where there is a dog or cat?
Please Select
Yes
No
Your Experience
Years of experience caring for Infants?
Years of experience caring for Toddlers?
Years of experience caring for Preschoolers?
Years of experience caring for School Age children?
Do you feel comfortable assisting kids with school work?
Please Select
Yes
No
Maybe
What is your favorite academic subject?
Which academic subject is most difficult for you?
What is your method of making sure you always arrive on time for work?
What would you do if you were stuck in traffic and were going to be late to work?
List some words that describe in-home child care to you:
List activities you notice children like:
List some words that describe your teaching style?
How many children have you cared for at one time?
Have you ever been employed as a full-time or part-time nanny?
Please Select
Yes
No
Have you ever been employed as a full-time or part-time teacher?
Please Select
Yes
No
Have you ever babysat in the homes of non-family members?
Please Select
Yes
No
Have you ever worked in a pre-school or elementary school?
Please Select
Yes
No
Have you ever worked in a middle school?
Please Select
Yes
No
Have you ever worked at a children's summer camp?
Please Select
Yes
No
Have you ever worked in a church nursery or children's room at a church?
Please Select
Yes
No
Have you ever worked in a daycare facility?
Please Select
Yes
No
Do you have experience caring for children with disabilities?
Please Select
Yes
No
Which disabilities do you have experience with?
How do you handle conflict with children?
How do you keep kids engaged throughout the day?
How do you keep kids safe?
Requirements
What is your hourly salary requirement?
Are you willing to help with light housework associated with toddler's meals and laundry?
Please Select
Yes
No
Which Type of Position are you applying for?
On-call
Full-time
Part-time
Live-in
Are you willing to provide a Covid-19 test result if you are hired?
Please Select
Yes
No
How did you hear about our agency?
Indeed
Care.com
Facebook
Craigslist
Google
Word of mouth
Other
Will you be looking for a Healthcare plan?
Please select
Yes
No
Already have one
Are you a non-smoker?
Please select
Yes
No
By typing your name below, you certify that the information contained herein is true and correct to the best of your knowledge:
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