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Name Address Home Phone Cell Phone Email Date of Birth Are you eligible to work in NZ Yes No Do you have your own vehicle? Drivers License # Yes No Any babysitting experience? Please tick which options suit you- Overnights Weekends Before School After School Which days are you available to work? Mon Tue Wed Thu Fri Sat Sun Hours Available to Work on each day? Tell us a little bit about you- Do you smoke Yes No Can you cook? Yes No Why would you like to be a babysitter? Emergency Contact- Name Phone e-Mail Relationship to you: References - Please give the details of two people to contact for references- Reference 1 Name Phone e-Mail Relationship to you: Reference 2 Name Phone e-Mail Relationship to you: Convictions Have you ever been convicted of any offence of the law? Yes No If Yes, please give details, include any traffic convictions. TERMS AND CONDITIONS DECLARATION I authorize Babysitters Club Ltd in accordance with the Privacy Act 1993, to collect and use my personal information and to contact the above referees. I declare that the information I have given is true and correct. I acknowledge that I have read, understood and shall abide by the Terms and Conditions. Tick this box to confirm you agree to making this declaration Yes No Copy this completed form then Click email and paste to send: babysittersclub@windowslive.com Any queries please contact us. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
