Sitter Solutions -  Sitter Application Please note all fields are Required on the application.  After you submit your application you will be contacted for an interview time Your name: Address: Cell: Phone: e-mail: Emergency  Contact: (name & relationship) Emergency  Contact Phone number: Please list all addresses for the last 5 years: Social Security Number: Date of Birth (optional): Driver's License Number: Exp. Date Yes No Have you ever been licensed in another State? Yes No Any tickets, arrest, charges, or convictions If yes, please explain: No Yes US Citizen? Have you ever been accused or substantiated as a perpetrator of child abuse or neglect investigated by a child-related social services agency? Yes No If yes, please explain: EDUCATION: College: Name: City & State GPA Year of Graduation Degree High School: Name: City & State GPA Year of Graduation Degree Other: (GED, Vo-tec, etc. Name: City & State GPA Year of Graduation Degree Please list any extracurricular activities while in High School and/or College: EXP Date CPR Yes First Aid? No Yes No EXP Date List any Child Development, Elementary or Special Education Classes: Yes Any experience with special needs in children? No Employment History: Employer 1: Add & Phone Hourly Rate Position Dates (to/from) Reason for Leaving: Employer 2: Add & Phone Hourly Rate Position Dates (to/from) Reason for Leaving: Employer 3: Add & Phone Hourly Rate Position Dates (to/from) Reason for Leaving: References: Name & Relationship Add & Phone Name & Relationship Add & Phone Name & Relationship Add & Phone *** Please have at least 2 written letters of recommendation.  You can bring them to the interview or have them e-mailed. Do you have your own Car? Full coverage Insurance? Yes No Yes No How far are you willing to drive one way to work? Yes No Liability only - Insurance? Disclaimer: We reserve the right to reject any candidate. To the best of my knowledge, all information on this application is true.  I understand that any false or misleading information or omission of pertinent information will result in the rejection of my application., or in dismissal if discovered subsequent to my association with Your Sitter Solution, LLC. Yes No I agree to the above Disclaimer Disclosure: This document serves solely as a clear and conspicuous written disclosure as required by the Federal Fair Credit Reporting Act set forth in section 604(b) to the Candidate that previous employment, education, social security, credit, motor vehicle report, and criminal background checks may be obtained for the purpose of this “Application” only.  By signing below, the applicant acknowledges this disclosure. Yes No I agree to the above Disclosure: Authorization: I authorize Your Sitter Solution, LLC to request reference checks, which include information on character and skills, education, driving and police records, past and present employment, addresses, social security number, and credit history. I permit Your Sitter Solution, LLC, to show this information to parents (if requested) as part of the evaluation process. I understand that all information in this application is requested in order to evaluate my qualifications for employment by parents as a child sitter.  I understand that I am not an employee of Your Sitter Solution, LLC, but shall be the employee of each individual family that hires me, responsible for paying any and all applicable taxes on any earnings. Your Sitter Solution, LLC is not responsible for any actions, circumstances or events that occur involving the applicant while performing any part of an agreement with Your Sitter Solution, LLC, including for negligence.  Applicant shall indemnify and hold harmless Your Sitter Solution, LLC, for any costs incurred in defending or paying for acts or omissions committed by the applicant, including reasonable attorney’s fees.   I understand that Your Sitter Solution, LLC, is not responsible for any act initiated by myself and I agree not to hold Your Sitter Solution, LLC, responsible for any and all claims including attorney fees and court costs made by any person arising out of my association. I agree to the above Authorization: No Yes Sitter Availability Schedule (Please select a minimum of 5 time slots during Mon. - Fri. & 1 time slots for Sat. & Sun.)        Day of the Week                  8 am - Noon             Noon - 5 pm           5 pm until ?             Monday Tuesday Wednesday Thursday Friday Saturday Sunday Do you work any place else? 2 home games 4 home games All home games Homecoming Game Please select the number of Football games you will be willing to work.   Not Available during the games: Do you belong to a Sorority? Please list responsibilities for homecoming, rush, formals, etc. Comments: Short Answer Questions: 1.  Why do you want to be employed as a nanny/sitter? 2.  Please summarize your experience with children.  Include your position, ages, numbers of children and the scope of your responsibilities. 3.  Please describe your family and your family background. What was it like when you were growing up? 4.  Please define your value system? (What is most important to you?) 5.  What do you consider your personality strength and weakness? 6.  What type of parenting style would you most likely use within your own family? 7.  What do you expect from the family you work for? 8.  Please describe your lifestyle and your interest. 9.  What is your experience with household management? 10.  Why are you looking for a new position? 11.  What did you like most and least about your most recent childcare position? 12.  What is a sample lunch for a 4 year old? 13.  What activities would you plan on a typical 8 hour day for a preschooler? 14.  Please describe how you would handle the following situation:  Bobby was struck by a baseball and is unconscious? Sitter Contract Sitter Rules: 1.  No friends are to accompany any sitter to a job. 2.  No visitors while at a job. 3.  Call the client 1-2 days before the assignment to confirm time and talk with client. 4.  Be on time and be reliable- providing the agency with 2-4 hours notice if unable to make a job. 5.  Be neat and tidy.  Pick up toy areas and bedrooms and other areas of the house used. Wash and put away dishes or load in dishwasher and run.  During downtime  (children napping- do something useful for the client- tidy kitchen, do a load of children’s clothes, organize play areas or toy closets, etc.). 6.  Do not use cell phones or take personal calls while working. 7.  Do not access internet/email accounts on client computers/internet providers. 8.  Answer the client’s phone as “ Hello.  __________ residence.”  It is important to answer the phone, as often the agency is trying to reach you or the client will call         to check in. 9.  Notify the agency if any client asks you to sit for an upcoming date.  Tell the client to contact the agency first. 10. Never take the clients children off the property unless you have permission.  Make sure you & the client have a clear understanding the nature of the trip and how the children will be transported.  It is a good idea to have a written approval for any trips in a car/truck. 11.  You are never to hit or shake any children; you understand that this is a critical or life threatening issue in children less than 2 years of age. 12.  The only approved discipline is “Time Out” with the removal of the child to a safe and secure setting, i.e. Bedroom or for older children the removal of a “reward item” i.e. bike, time out side, treats, special movie, etc. Agency Procedures:         1.  All hit and miss jobs are on a first come first serve basis. 2.  Call in new schedules early if you want regular scheduled hours. 3.  Notify agency of all clients who ask you to sit without contacting the agency. 4.  Notify agency of any problems or client complaints the day of assignment. 5.  Pay the appropriate fees/penalties in a timely fashion to avoid deactivation without recommendation. 6.  Summer nanny positions and semester standings are done on a wait list basis. 7.  Notify agency of address changes. 8.  Any requested time off is subject to verification at any time. If verification is not produced sitter will be fined, deactivated, or both at the discretion of the owner of the agency. Sitter Fees/Penalties: 1.  All sitters will be notified in writing of fee changes.  (Note will be sent to address listed with agency, please keep updated to be aware of all changes) 2.  The following penalties apply to all sitters: -If the agency receives a call from a client complaining the sitter was late, a $10.00 fee will be imposed to cover the cost of compensating the call to the client and due upon notification of the complaint.      -If you fail to show to a scheduled standing (not including days requested off), the appropriate fee will be imposed and due upon notification to cover the cost of compensating the client an additional week of the standing.  This may result in a standing being pulled and given to another sitter.  Any time off is subject to verification as stated above.      -Failure to show at a job results in larger fees being imposed and/or deactivation without recommendation. I have read and understand the above contract.  I agree not to contact any client of Sitter Solutions, LLC without notifying the agency ahead of time.  I agree not to contact any client of Sitter Solutions, LLC after my affiliation with Sitter Solutions, LLC has ceased.  I understand that liquidated damages may be assessed if this contract is violated in the amount of $3,500.00. Name: Date: