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.

Do you have any special skills or qualifications (i.e. experience with twins, NICU grads, etc)

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 two references we can contact:

Is there any other information you'd like to share?

If available, please upload resume/CV:

Job Reference # (if applying for a specific job):

Candidate Signature

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