Childcare Background Assessment Form
Evaluate a childcare provider or applicant’s background, experience, safety practices, work history, and suitability for childcare responsibilities.
Full Name of Applicant
*
First Name
Last Name
Contact Information (Phone or Email)
*
How many years of experience do you have in childcare?
*
Which age groups have you cared for? (Select all that apply)
*
Infants (0-1 years)
Toddlers (1-3 years)
Preschool (3-5 years)
School-age (5+ years)
Other
Please rate your knowledge of child safety practices.
*
1
2
3
4
5
Describe a safety protocol you follow when caring for children.
*
Work History in Childcare (List recent positions and durations)
*
Reference 1 (Name and Contact)
*
Reference 2 (Name and Contact)
*
Based on your assessment, how suitable is the applicant for childcare responsibilities?
*
Rows
Suitability Rating
Not Suitable
1
Somewhat Suitable
2
Suitable
3
Highly Suitable
4
Submit Assessment
Should be Empty: