Deaconess Center Caregiver Interest Form

Thanks for your interest in providing childcare as an independent contractor at the Deaconess Center for Child Well-Being.

Process:

Please completed the Interest Form below along with a completed W-9. After your interest from is submitted, Deaconess Foundation will request a personal background check. You will receive an e-mail from "Justifacts" requesting your authorization to run a personal background check. Once authorized, the background check typically processes in 2-3 business days. Once the background check is completed, Deaconess Foundation will ask you to attend an in-person group orientation. After you have completed the required orientations, Deaconess Foundation will add you to the e-mail listserv where you will be emailed upcoming childcare opportunities at Deaconess Center. Sign up for childcare opportunities are first come, first-serve basis.

Compensation:

Independent contractors for childcare at Deaconess Center will be paid an hourly rate of $20/hour paid via check. At the end of each shift, contractors will sign invoice detailing the number of hours worked. Invoices will be processed weekly. Note: If an independent contractor receives more than $600 in a calendar year from an institute, they are required to be sent a Form 1099-MISC and self-report their own taxes to the IRS.

First Name *

Last Name *

Pronouns *

Email Address *

Phone *

Organization

Street *

City *

State *

Zip *

Are you at least 18 years of age? *

Yes

Please describe any personal or professional experience you have had in providing direct child care *

Days and times available to provide child care *

Weekdays

Weekends

Business Hours (8 am to 5 pm)

Evening Hours (5 pm to 9 pm)

Do you give permission to Deaconess Center to perform a personal background check? *

Yes

Please upload completed W-9. *

Access a fillable W-9 form here.

Comments/Additional Information