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join our team
First name
*
Last name
*
Email
*
Phone
Birthday
*
Month
Day
Year
Address
*
Years of Newborn Experience
*
Are you authorized to work in the United States?
*
Yes
No
Do you have access to a reliable vehicle and valid driver's license?
*
Yes
No
Are your first aid/CPR certifications current?
*
Yes (will provide proof upon request)
No
Area(s) of Expertise
*
Postpartum Doula
Night nanny
Newborn Care Specialist
Other
Have you received a TDAP vaccine in the past 10 years? (asked for matching purposes only)
*
Yes
No, and unwilling
No, but willing
Have you received a flu vaccine in the past year? (asked for matching purposes only)
*
Yes
No, and unwilling
No, but willing
Certifications and trainings
*
Do you have lactation support experience? If yes, what is your training/level of comfort?
*
Please describe your relevant newborn care employment experience. Include dates of employment, ages of child(ren) at start of employment, and scope of work. Note: If you have a resume attached that details this, you may write "see resume"
*
Do you have any special skills or qualifications (i.e. experience with twins, NICU grads, etc)
*
Please describe your caregiving style
*
A family asks for advice that falls outside your scope of practice. How do you respond?
*
Tell us about a time when you disagreed with a client's decision. How did you handle it?
*
How do you decide when to educate, when to offer suggestions, and when to simply provide support?
*
What does "evidence-based care" mean to you in the context of postpartum and newborn support?
*
What does a safe sleep environment look like to you?
*
Describe your ideal client
*
What is your desired location/radius for placement opportunities?
*
How soon would you be available for a new opportunity?
*
What is your desired shift?
*
Day
Night
Desired hourly rate
*
How many days/nights per week are you looking to work?
*
Do you have any days of the week or specific dates that you are unavailable?
*
Are you willing to submit information for a formal background check?
*
Yes
No
Do you carry liability insurance? *Note: we require our contractors to carry their own liability insurance and submit proof.
*
Yes
No
Please list at least two references we can contact via email:
*
Is there any other information you'd like to share?
If available, please upload resume/CV:
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Job Reference # (if applying for a specific job):
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