Baby Nurse Application

Ready to apply to be a Baby Nurse? Simply fill out the application below or download the PDF application, complete and send it to:

Rachel's Infant Care
P.O. Box 4
Trion, GA 30753
(866) 727-4729

* denotes required fields.

Baby Nurse Application
Name *
First

Last
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone Number *
(###)

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###

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Mobile Phone Number
(###)

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-

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Email Address *
Social Security Number
Do you have children?
Yes No
If yes, what are their ages?
Are you married?
Yes No
If yes, what is your spouse's name?
First

Last
Driver's License Number
Do you have an automobile?
Yes No
If yes, please give:
Make
Year
Insurance Carrier
Insurance Phone Number
(###)

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###

-

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Insurance Policy Number
Education
Name of Highschool or Academy
Year Graduated?
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Name of College
Year graduated?
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Major, or courses taken
Special Study courses (such as infant courses )
Are you certified in infant CPR?
Yes No
If yes, date of certification:
MM

/

DD

/

YYYY
Record of Profession or Occupation

(Please list the two most recent)
Name of Employer
Type of work
Years employed
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone Number
(###)

-

###

-

####
Name of Employer
Type of work
Years employed
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone Number
(###)

-

###

-

####
Character References

(Please do not list relatives or employers)
Name
First

Last
Relationship
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone Number
(###)

-

###

-

####
Name
First

Last
Relationship
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone Number
(###)

-

###

-

####
What is your experience with infants?
Do you have any experience with special needs babies?
Yes No
If yes, please explain:
List two references of people you have done Infant care for:
Name of Employer
First

Last
Years of employment
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone Number
(###)

-

###

-

####
Name of Employer
First

Last
Years of employment
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone Number
(###)

-

###

-

####
What is your interest in Rachel's Infant Care?
What is the minimum amount you need to earn Monthly?
How did you find out about Rachel's Infant Care? * *
A Baby Nurse will not give medical advice or treatment to baby, mother, or any one else. We are not Qualified to give such advice.
If you agree to the terms of this contract, check the box. *
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Baby Nurse Application

Baby Nurse Application

Education

Record of Profession or Occupation

Character References