Sitters At Your Service, LLC EMPLOYMENT APPLICATION Please mail to: P.O. Box 43021 Richmond Heights, OH 44143 216-323-7800 info@sittersays.com Sitters At Your Service, LLC is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age, race, color, sex, religion, nation origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.
PERSONAL Last Name First Middle Name Maiden Social Security # Other Name(s) Used (Nickname) Home Telephone # ( ) Home Address City State Zip Code Business or Cell # ( ) Position Desired: Baby sit, House sit, Pet sit, Elder Care, All (Circle) Have you worked with special needs children: Y N Referred By Age: E-mail Address: If yes, in what area: (Deaf, ADD, ADH etc.) Are you a U.S. Citizen Yes No If no, are you eligible to work in the US Yes No VISA # Do you have any relatives employed by the Company? Yes No Are you at least 18 years old? Yes No If yes, list name (s) Do you Smoke? EDUCATION Circle Highest Grade Completed: High School 9 10 11 12 College, Trade or Business 1 2 3 4 Graduate Studies School Address Major Studies Degree, Diploma, License or Certificate High School College/University Vocational, Business, Other List Any Certifications: (CPR, Baby sitting Certificates, etc.) Do you know a second language (Spanish, sign language etc?) Do you have any medical conditions: If yes, describe: Do you have any allergies: Do you take any medications? If yes, What? If yes, What?
EMPLOYMENT HISTORY List all employments for the past 10 years, starting with the most recent position. All information must be completed. You may attach a resume, but not in place of completing the required information. Employed From Employed Until Job Title Duties & Responsibilities Employer Name Supervisor Name Starting Salary Employer Address Supervisor Phone # Ending Salary Reason for Leaving Employed From Employed Until Job Title Employer Name Supervisor Name Starting Salary Employer Address Supervisor Phone # Ending Salary Reason for Leaving Duties & Responsibilities Emergency Contact Information: Childcare Reference Contact Please list current childcare references which are not related to you. Cell # Cell # Cell# Indicate all available days and times: Monday: Tuesday Wednesday Thursday Friday Saturday Sunday Rate of pay you would like: Cell# How many hours a week would you like to sit: What age of children would you like to work with Are you available at least 2 weekends a month: What is the maximum # of children you can work with Are you willing to work holidays/special events Are you willing to make meals during shift List any outside dates you can t work Are you willing to do laundry/dishes When can you begin to work
GENERAL Yes No May we contact your current employer/personal references for past work experience? If hired, will you be able to work overtime? Will you be able to perform the essential job functions for the position you are applying for with or without reasonable accommodation? Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged or seals by court? (A yes response does not automatically disqualify your application.) Do you understand that corporal punishment (spanking) is an unacceptable for of discipline a Sitters At Your Service, LLC client and is under NO circumstances to be used while a child/adult/pet is in your care.
CERTIFICATION & AUTHORIZATION This shall be deemed an integral part of the agreement between the sitter and Sitters At Your Service, LLC. The sitter herby represents and agrees that the relationship between the sitter and Sitters At Your Service, LLC, is that of independent contractor and no agency relationship has been or will be created between them. The sitter agrees to identify and hold Sitters At Your Service, against any and all damages, claims, actions, cost and expenses, including attorney s fees, asserted by a person and arising out of or otherwise relating to the rendering of, or failure to render, any service by Sitters At Your Service, LLC or the sitter. I authorize the Company to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I further authorize the Company to obtain any credit and consumer check.. The above information is true and correct. I understand that, in the event of my contract is accepted by Sitters At Your Service, LLC, I shall be subject to dismissal if any information that I have given in this application is false or misleading or if I have failed to give any information herein requested, regardless of the time elapsed after discovery. The undersigned client hereby agrees not to directly or indirectly compete with the business of SittersAYS and its successors and assigns during the period of agreement and for a period of five years following termination of agreement. The term not compete as used herein shall mean that the client shall not own, manage, operate, consult or to be employed in a business substantially similar to, or competitive with, the present business of the SittersAYS or such other business activity in which SittersAYS may substantially engage in. This non-compete agreement shall extend only for a radius of 120 miles from the present location of the company and shall be full force and effect for five years, commencing with the date of agreement termination. The sitter further agrees that for a period of one year following the termination of the agreement with Sitters At Your Service, LLC for any reason, the sitter will not work for any client of Sitters At Your Service, LLC, unless first obtaining the consent of Sitters At Your Service, LLC and agreeing to work for such client on in full compliance with the procedures and requirements of the sitters agreement of Sitters At Your Service, LLC then in use. If you sit for a Sitters At Your Service client without our permission they will be charged a $500 fee and you can be terminated. I hereby acknowledge that I have read and agree to the above statements. Signature Date