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Postpartum helper application form
We are looking for potential postpartum helpers. This form will take approximately 5 minutes to complete
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* Indicates required question
Name
*
First and last name
Your answer
Email
*
Your answer
Phone number
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Race
*
Your answer
Do you have your own children?
Yes
No
Other:
Clear selection
If Yes, how many children do you have and how old are they?
Your answer
What are your preferred working hours?
*
9am - 2pm
11am- 4pm
1pm - 6pm
Other:
Knowledge of confinement
*
Poor
1
2
3
4
5
Excellent
Care of new born
*
Poor
1
2
3
4
5
Excellent
Laundry
*
Poor
1
2
3
4
5
Excellent
Cooking
*
Poor
1
2
3
4
5
Excellent
Languages spoken
*
Your answer
Any experience or additional skills
Your answer
Thank you for your time! We will review your entry and get back to you as soon as possible.
Contact us at
suzushimajp@yahoo.co.jp
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