Caretakers application form:
Present Address, City,State:
Describe your capabilities:
Activities other than religious(Civic, Athletic, Hobbies, Interests, etc.)
Grammar School
High School
College
Trade or Business
School
Year Completed
19xx or 20xx
References Give below the names of three persons not related to you that you have known at least one year.
Years
Name City/State Phone# How Known Acquainted
Physical Record: Do you have any physical condition which may limit your ability to perform the responsibilities?
This question is voluntary and any answers will be kept confidential.