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Candidate application

Interview Application

Crunch Care, A Nanny, Babysitter, and Caregiver Referral Agency

Please fill out this application in as much detail as possible.

*Please note that if you are represented by Crunch Care to be referred to employment opportunities you may be required to provide the following items:

2 forms of government approved ID such as a Drivers License and a Social Security Card OR a US Government issued Passport
additional references or letters of recommendation
any fingerprinting paperwork or additional certification such as CPR/First Aid, nursing licenses, etc

Privacy Policy.

Employment Agreement. (Private Client cases Referral, Corporate and designated cases Employment)

Click here to review the Fair Credit and Reporting Act Summary.

Do’s and Don’ts!

Application

If this application is properly completed your interview should take about 20 minutes. IF YOU DO NOT SEE A CONFIRMATION THAT YOUR APPLICATION HAS GONE THROUGH IT HAS NOT. PLEASE REVISIT THE FORM MAKING SURE ALL REQUIRED FIELDS HAVE BEEN FILLED IN. We look forward to meeting you. * indicates a required question to answer.

Candidate Application

Location*
Please select areas in which you are looking for work.
Name*
First Name Last Name
How did you hear about us*
Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Text Messaging:
- Yes it is okay to text my cell phone.
Alternate Phone
Email*
Social Media Account (Include Link)*

Plug in as many as you have as clients will review your social media from time to time
Requested pay rate (can provide range):
Are you willing to drive?
Enter car make, model and year (optional)

Enter if possible as clients who require driving may request info.
Please let us know how many minutes you are willing to commute:*
Are you a smoker?
- Yes
- No
Vaccinated for Covid-19
- Yes
- No
Please check off either Full-Time, Part-Time, or both:*
- Part-Time (less than 34 hours per week)
- Full-time (more than 35 hrs per week
Please select what type of employment you are open to. You may select more than one*
- Short-Term Care
- Long-Term Care
Please write a paragraph about why you want to be a care provider, what you are doing with your life today, and what experience you have that has led you to this:*
This is a mandatory part of our application process. Please be through and descriptive using grammatically correct language. This will used to present your background to our clients. We are open if you are more comfortable to using your native language if needed and translating.
Please indicate your areas of experience and general personality questions. You may check more than one.*
- Newborn (birth to 3 months)
- Multiples birth (Experience with twins, etc)
- Premature birth
- 4-6 months
- 7-18 months
- 19 months-3 years
- 4-12 years
- 12+ years
- Postpartum
- Elder Care
- Post-Surgical
- Dementia/Alzheimer's
- Housekeeping
- Household Assistant
- Pet Sitting
- Energetic
- Soft Spoken
- Soothing
- Empathetic
- Compassionate
- Creative
- Imaginative
- Good Listener
- Flexible
- Understanding
- Observant
- Optimistic
- Charming
- Confident
- Reliable
- Helpful
- Discreet
- Independant
- Intelligent
- Precise
- Encouraging
- Exhuberant
- Outdoor Sports
- Scrapbooking
- Theater
- Quilting
- Crocheting
- Party Planning
- Board Games
- Writing
- Problem Solving
- Time Management
- Tutoring
- Transferring Care Recipients
- Dementia/Alzheimer's Exp
- Special Needs Exp
- Social Perceptiveness
- Judgement and Decision Making
- Active Learning
- Customer Service
- Reading
- Cooking
- Choir
- Knitting
- Sewing
- Arts and Crafts
- Music
- Video Games
- Meal Prep
- Effective Communicator
- Organizing
- Hoyer Lift Exp
- Lift Belt
- Autism Exp
- Coordinating Activities
- Active Listening
- Instructing
- Learning Strategies
- Detail Oriented
Please indicate any education or certificates in the following areas.
- CNA
- Companion
- HHA Home Health Aid
- Nanny
- PCA Personal Care Attendant
- PCP Personal Care Practitioner
Do you have Trustline or have you worked in a CA preschool? Please give the details.
Are you certified as a lifeguard
- Yes
- No
Experience in years with Adult Care
Experience in years with Azheimer's
Experience in years with Autism
Experience in years with Infants
Experience in years with Preschoolers
Experience in years with School Age Children
Experience in years with Special Needs Cases
Experience in years with Teens
Experience in years with Toddlers
Experience in years with Young Adults
Experience with Multiples
Driver's License Number:*
Are you able to confirm employment eligibility with the proper documents?*
- *Yes I am legally eligible to work in the United States and I can provide documentation to confirm my eligibility
- *No I am not legally eligible to work in the United States and can not provide documentation to confirm my eligibility
EMPLOYMENT/VOLUNTEER HISTORY
(please provide from most recent and back in dates)
Most recent employer/volunteer organization (please include full name) #1:*
Dates of employment/volunteer service (must include month and year of start and end date) #1:*
Telephone number for reference (provide best number to contact) #1:*
Email to contact for reference #1:
Detailed job description #1:*
Reason for leaving #1:*
Full address of location #1:*
Street Address Address Line 2 City State ZIP Code
Employer #2/Volunteer Organization (please include full name):
Dates of employment/volunteer service (must include month and year of start and end date) #2:
Telephone number for reference (provide best number) #2:
References email address #2
Detailed job description #2:
Reason for leaving #2:
Full address of location #2:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employer #3/Volunteer Organization (please include full name):
Dates of employment/volunteer service (must include month and year of start and end date) #3:
Telephone number for reference (provide best number) #3:
References email address #3
Detailed job description #3:
Reason for leaving #3:
Full address of location #3:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Check The Following Boxes that Apply:
- I would be willing to take additional courses
- I would not be willing to take additional courses
Please detail additional experience related to the field:
Please list certifications and licenses such as Trustline, CPR and First Aid, etc.:
High School name and city:
How many years attended:
University name and city:
How many years attended:
Received degree in:
Cumulative G.P.A. (University if applicable):
Post-graduate studies (please describe if any):
Address History
Please fill out the section below in as much detail as possible so we fully understand your availability.
Note: It is not necessary to indicate the need for absences due to religious practices or obligations
Total weekly hours requested including schedule special requests:*
Please indicate what you are willing to do in the workplace by checking the boxes. This will allow us to make an appropriate match for you. The following list is applicable for child care. Fill out this section only if you want to do child care.*
- Live-In
- Live-Out
- Driving (must be willing to take DMV background check)
- Misc. errands
- Reading aloud
- Grocery shopping
- Meal planning and preparation
- Changing bed linens
- Making beds
- Vacuuming
- Dusting
- Laundry
- Household organization
- Dog walking
- Pet feeding
- Plant maintenance
- Mail pickup
- Walks or outdoor activity
- Sweeping
- Night feedings
- Sleeping in newborns room
- Care of umbilical cord
- Care of circumcision
- Newborn bathing
- C-section recovery
- Birth of multiples
- ADLS (activities of daily living)
- Alzheimer's
- Dementia
- Bathing assistance
- Emptying colostomy or catheter bag
- Incontinence
- Recording medication dosing
- Lifting to stand
- Assisting with oxygen or nebulizer
- Transporting in and out of wheelchair
- Working with terminally ill patients
- Working with patients undergoing dialysis
- Working with patients undergoing chemotherapy or radiation
- Helping with feeding tubes
- Working with patients that may smoke
- Range of motion exercises
Please list any allergies you may have to pets:*
Please check if you are a smoker:
- Smoker
I have clicked on this link above and reviewed the Crunch Care Referral/Employment Agreement. I am entering my initials in the box below to constitute my acceptance of the terms of the Referral/Employee Agreement.*

I understand that long term search placement are by referral only assigned temporary cases and designated actual Employment via Crunch Care.
By entering my initials below I have agreed that I have read and reviewed the Fair Credit and Reporting Act Summary above.*
By entering my initials in the box below (scroll down form to enter initials and submit form), I understand and agree to the following terms: I certify that all information that I provided in this application is true, accurate, complete and correct. I authorize investigation of all information provided in this application. I authorize the parties and entities I listed in this document to provide all information they may have regarding me and my character. I authorize the disclosure of any information about me, including but not limited to information obtained from the parties and entities I listed in this document, to Crunch Care Inc. ("Crunch Care"), its affiliated entities and representatives, and clients and potential employers. I understand and agree that any misrepresentation, falsification or material omission of information on this application may be grounds for Crunch Care to refuse to refer or place me. I understand and agree that Crunch Care does not unlawfully discriminate in referrals or placements, and that no question on this application is used for the purpose of limiting or excusing any applicant for consideration for referral, placement or employment on any basis prohibited by applicable laws or regulations. I further understand and agree that Crunch Care does not guarantee my referral, placement, employment or any terms of employment. To the maximum extent allowed by law, I specifically release Crunch Care and its owners, agents, employees, officers, directors, attorneys, representatives, and clients, and all of their affiliated entities and representatives, from any and all liability as a result of soliciting, providing or receiving information regarding me or my character, or the use or disclosure of such information. Disclaimer/Waiver/Hold Harmless/Limitation of Liability: Crunch Care assumes no liability or responsibility for, and makes no representations or warranties about, any information, material, errors, omissions, or services it provides. I understand and agree that my use of Crunch Care’s services is at my own risk. Except as specified herein, Crunch Care does not provide and specifically disclaims any express or implied guarantees or warranties to me. Additionally, Crunch Care does not employ or exercise control or discretion over clients and disclaims all responsibilities for clients’ conduct or omissions. To the maximum extent allowed by law, I hereby waive and release Crunch Care and its owners, agents, employees, officers, directors, attorneys, and representatives, and all of their affiliated entities and representatives, from all liability, including but not limited to liability arising from negligence or the actions of any third party (including but not limited to clients, potential clients, or referrals), arising under law or otherwise. This document does not govern claims that cannot be released by private agreement or that cannot lawfully be waived. In addition, this document does not limit either party’s right, where applicable, to file, cooperate with or participate in an investigative proceeding of any governmental entity, or to file charges that do not seek personal relief for released claims with any governmental entity. Additionally, I shall indemnify, defend and hold Crunch Care and its owners, agents, employees, officers, directors, attorneys, and representatives, and all of their affiliated entities and representatives, harmless against any damages or liability whatsoever arising out of or in any way in connection with my referral to or employment or association with Crunch Care's clients, regardless of how, when, or where any damages or liability was incurred. Finally, in no event shall I or Crunch Care and its affiliated entities and representatives be liable to each other for consequential, incidental, exemplary, punitive, special or indirect damages of any kind. If any exclusion or limitation of damages is not permitted by law, the parties’ liability to each other is limited to the maximum extent permitted by law. Miscellaneous This agreement shall be governed by and interpreted according to the laws of the State of California. Any action or proceeding commenced regarding this agreement shall be brought in San Diego County, California. The parties enter into this agreement without reliance upon any statement, representation, promise, inducement, or agreement not expressly contained herein. This agreement constitutes the entire agreement between Crunch Care and me and supersedes all prior oral and written agreements between Crunch Care and me with respect to the subjects covered in this agreement. This agreement shall not be amended or modified except in a mutually agreed upon writing signed by me and an authorized representative of Crunch Care. I represent that I have carefully read and fully understand the scope and effect of all of the provisions of this agreement; that I have had all such time that I desire to consider the agreement; that I had the opportunity to consult with an attorney of my own choosing and at my own expense to review this agreement; and that I have availed myself of this opportunity to the extent, if any, that I wished to do so. The terms of this agreement are severable. The invalidity or unenforceability of any provision within this agreement shall not affect the application of any other provision, provided that the essential terms and conditions of this agreement for each party remain valid, binding and enforceable. Further, consistent with the purposes of this agreement, any otherwise invalid provision of this agreement may be reformed and, as reformed, enforced by any party to this agreement. This agreement may be executed in counterparts, each of which shall be deemed to be an original. Such counterparts, when taken together, shall constitute but one agreement. Failure or delay on the part of either party to exercise any right, remedy, power or privilege under this agreement shall not operate as a waiver of any other right, remedy, power or privilege. A waiver, to be effective, must be in writing and must be signed by the party making the waiver. A written waiver of a default shall not operate as a waiver of any other default or of the same type of default on a future occasion. Neither party shall assign or transfer this agreement or any interest herein without the prior written consent of the other party. The rights and remedies provided in this agreement shall be the sole and exclusive rights of the parties against one another relating to the subject matter of this agreement. The section captions contained in this agreement are for convenience only and do not constitute a part of its terms and provisions. CA Civil Code Sec. 1812.5095 Disclosure I understand and agree with the following: Crunch Care will attempt to refer me to its clients for childcare services. The client will pay Crunch Care's placement fee. I am free to sign an agreement with other employment agencies and to perform domestic work for persons not referred by Crunch Care. I will inform Crunch Care of any work restrictions I may have and am free to select or reject any opportunity offered by Crunch Care. I am free to re-negotiate with the person hiring me the amount proposed to be paid for my work, and will notify Crunch Care of any such change in compensation. I did not and will not receive training from Crunch Care with respect to the performance of my work. I will perform my work without any direction, control, or supervision by Crunch Care, and Crunch Care does not provide tools, supplies or equipment necessary for me to perform my work. Rather, the client will be solely responsible for my direction, supervision, control and compensation, and the client will be my employer. I am not obligated to pay Crunch Care's placement fee, and Crunch Care is not obligated to pay me if my employer does not pay me for my services. Payments from my employer will be made directly to me. My employment with a client may be terminated either by me or the client, but not by Crunch Care. Crunch Care has informed me and I understand and agree that I may be obligated to obtain business permits or licenses, where required by any state or local law, ordinance or regulation, and that I am not eligible for unemployment insurance, state disability insurance, social security or workers’ compensation benefits through Crunch Care. Finally, if I am self-employed, I understand and agree that I am required to pay self-employment tax, state tax and federal income taxes.*
**Please print and retain a copy of this application for your records.** CLICK THE SUBMIT BUTTON BELOW
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