Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How far are you willing to travel for a shift? *

Up to 10 miles

10–20 miles

20–30 miles

Over 30 miles

Do you acknowledge that Unyik Care operates as a small contracting business, and payment is processed 30 days after the end of the previous month? *

Yes

No

Are you comfortable with the payment schedule described above? *

Yes

No

Do you have at least one year of experience working with children? *

Yes

No

Have you worked with children involved in Child Protective Services (CPS) cases? *

Yes

No

Do you have a current negative TB within the last year? *

Yes

No

Do you have experience with children who have special needs or behavioral challenges? *

Yes

No

What age groups of children have you cared for? *

Infants (0–1 year)

Toddlers (1–3 years)

Preschoolers (3–5 years)

School-aged children (5–12 years)

Teenagers (13+ years)

Have you ever been involved in a Child Protective Services (CPS) investigation? *

Yes

No

Are you at least 21 or older? *

Yes

No

Have you been employed by the State of Texas at any time in the last 3 years? *

Yes

No

Have you ever missed a scheduled shift without prior notice? *

Yes

No