1. Name:
____________________________________________________
2. Age: _____
4. Children: Yes or No, (Circle one) If yes, ages:
5. What appeals to you about taking care of children?
6. Describe your childcare experience?
7. How would you discipline a child?
_______________________________________________________
8. Have you ever had to deal with an Emergency? If so, what happened and how did you handle it?
_______________________________________________________
9. What do you find to be the most challenging aspect of working with children?
10. What do you like to do in your free time?
11. How do you think your closest friends would describe you and your personality with children?
12. How would you handle a crying baby?
13. How would you handle a temper tantrum?
14. How do you feel about toilet training?
15. Have you had any recent illnesses which might in anyway hinder your ability in caring for the children?
____________________________________________________
16. Do you have dependable transportation?
____________________________________________________
18. Have you ever been in trouble with the law?
____________________________________________________
19. Are you willing to go to Trainings yearly? ___________________
20. Do loud noises bother you? ___________________________
21. Do you have CPR or First Aid training? ____________________
22. How do you feel about changing diapers? __________________
23. Do you like to clean and cook? ___________________________
24. Can you get down on the floor and play with children? ________
25. Do you smoke? ____________
26. How would you do in specific scenarios such as if a child was upset on their first day? _______________________________________________________
27. What you think could you influence the