Please enter your availability in the table below. Indicate both start and end times.
Note: Employment here may require occasional or regular weekend shifts
What is the earliest possible date you would be available to work?
Are you seeking temporary employment?
If yes, indicate end date
Do you have reliable transportation? Yes No
If yes, please indicate primary type: Car Busline
Please indicate distance you are willing to travel to and from work (i.e., distance, time and/or cities).
Please list any allergies which would affect you working in a household.
Other (please list)
Please indicate any employer you do not want contacted
(or unpaid) experience:
Special skills or talents (CPR, sign language, etc.)
Please list if you are fluent in any language besides English.
(supervisor from previous work experience or a teacher--not a co-worker)
This job may require the lifting/carrying of small children across the room or up/down the stairs.
I hereby declare the information provided by me in this application for employment is true, correct
and complete to the best of my knowledge. I understand that, if employed, any mis-statement or
omission of fact on this application shall be considered cause for dismissal. I hereby authorize
ATC to verify any information by contacting former employers, unless otherwise stipulated. I also
consent to a criminal background check conducted by ATC for $16.00, which will be deducted from
my first paycheck in the event of employment.
When you've finished completing your form, click the Submit button to send it to us.
Do not click Submit more than once!