Educator Application

    Name

    Are you over 18 years of age?

    YesNo

    Home Phone

    Email


    Type of home?

    Community

    Do you have a fenced yard?

    YesNo

    Do you or anyone in your home smoke?

    YesNo




    Currently employed?YesNo

    Employment

    Employer

    Are you on social assistance?YesNo


    Mon

    Tue

    Wed

    Thu

    Fri

    Would you be available to provide evening care?YesNo


    Do you have any children?YesNo



    Do you have any pets?YesNo



    Have you applied to and/or worked with another day home agency?YesNo

    Do you have any work experience in childcare?YesNo


    Do you have first aid certification?YesNo

    Could you provide 3 childcare references if needed?YesNo

    Do you own any essential child care items (crib/highchair/stroller)?YesNo