Name
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First Name
Last Name
Email
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Phone
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(###)
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What is your address?
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Date of Birth
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MM
DD
YYYY
Relationship Status
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Married
Single
In a relationship
Do you have other children? If so, how old are they?
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Do you have any family or other responsibilities that would limit your availability as an apprentice?
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What other commitments do you have in your life? Are you ready to be on call 24/7, including holidays?
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Do you live within 30 minutes of our Birth Center in New Braunfels? If not, are you willing/able to relocate for the duration of your apprenticeship?
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Do you have a depenedable car available full time?
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Are you active on social media? If so, feel free to add your handles here if you'd like!
Why do you want to become a midwife?
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Tell us about your future plans in midwifery. Do you have any dreams for after licensing?
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Describe the qualities you like best about yourself. What do you feel are your weaknesses?
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At times the demands of midwifery as an apprentice can be overwhelming. Please describe how you handle stress.
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Do you have any physical/health conditions which might limit your ability to work long, irregular hours?
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The staff midwives at JBBC are Christians, and are open about their faith within their practice. Do you feel this is something you would work well with, or are there concerns for you? Do you yourself have any personal religious preferences/needs you would like us to be aware of?
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What is your educational background? Are you fluent in any other languages?
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Do you have any skills you would like for us to know about? (i.e- administrative background, computer skills, teaching, cleaning, organizing, clinical skills etc)
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Have you had any prior experience working with pregnant/birthing women? (ex: childbirth educator, LLL Leader, WIC Counselor, Nurse, etc)
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Have you attended births in any capacity? If so, please elaborate.
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Are you currently enrolled in an academic midwifery program? If so, which one? How much have you completed, and how much do you have remaining?
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If you have ever begun an apprenticeship with someone else, who was your preceptor and why didn’t you complete the apprenticeship?
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Have you ever had a job? If so, can you provide us with names and phone numbers as references?
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How did you learn of our practice?
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Do you have any questions, concerns, comments or desires you'd like us to know about?
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Do you have a particular timeline for which you are hoping to begin an apprenticeship?
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If the decision is made to move forward together, we will do our best to find a time in the schedule that is convenient for all parties. Do you have any preferred days/times that are better for you to do an in-person interview?
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