Join the Registry

About Me

Name*

Full Name

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email

Why are you interested in joining the Ray of Sunshine Registry?*

Services Provided & Preferences

I am qualified and willing to provide the below services:*

I am willing to accept contracts for the below time periods:*

Hourly Rate*

Please enter your typical rate for hourly contract care

24/7 Rate*

If you do not provide 24/7 "live-in" care please enter 0.00

Trip / Transportation Charges*

If you do not provide transportation please enter 0.00

Please Indicate any Holiday for which you charge time and a half*

I am available for contracts in the following locations:*

Please provide additional details about availablility:*

Experience

Company or Client

Name

Address

Street Address Address Line 2 City State ZIP Code

Contact Name

Full Name

Contact Email

Contact Phone

Reason for Leaving

Company or Client

Name

Address

Street Address Address Line 2 City State ZIP Code

Contact Name

Full Name

Contact Email

Contact Phone

Reason for Leaving

Company or Client

Name

Address

Street Address Address Line 2 City State ZIP Code

Contact Name

Full Name

Contact Email

Contact Phone

Reason for Leaving

Education & Training

Please Indicate Highest Grade Completed*

Please list name and location of most recent high school:*

High School Graduate*

Yes
No
GED

Please list any other skills, training, courses of study or professional certifications as applicable*

Resume, Certificates or Transcripts

Drop files here or

Max. file size: 128 MB, Max. files: 5.

References

Name*

Full Name

Relationship*

Phone*

Email

Name*

Full Name

Relationship*

Phone*

Email

Name*

Full Name

Relationship*

Phone*

Email

Can we contact your current employer or client?*

Yes
No
N / A

Certification & Release

I certify that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this submission may result in being denied a contract or staff position at any time with Ray of Sunshine. I authorize Ray of Sunshine and its agents, including consumer reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle records. I release all persons, schools, companies and law enforcement authorities from any liabilities for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during my association with Ray of Sunshine. I am willing to submit to drug testing to detect the use of illegal drugs before and during this time if so required or requested by the client and/or their responsible party. Illegal drugs include any drug which is not legally obtainable or which is legally obtainable but has not been legally acquired or administered.*

Typed Name

Date*