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Describe any specialized education you've received in Newborn Care:
Describe any other related courses or training you have taken:
Do you have experience with special needs infants? Please describe:
Do you have any health problems that could interfere with your ability to be a childcare provider? If so, please explain:
Have you been ticketed for any reason or had a traffic accident in the past 5 years? If so, please explain:
If the answer to either or both of the above is yes, please explain:
(If Yes, list phone number and contact name. If No, state reason.):
Positions Held:
Job Duties:
Reason for Departure:
Please indicate below the times you are available to work as well as your class schedule or any other regular events that would prevent you from working:
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