Nanny/Caregiver Application Form

Basic Details

*Name
*Address
Apt/Suite
*City
*Province	Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
*Postal Code
*Email
(Optional) Date of Birth
Social Insurance Number (SIN) will be provided upon request
*Phone (Home)
Phone (Cell/Mobile)
Emergency Contact Name
Emergency Contact Phone

Education and Related Experience

Please, list in reversed chronological order.

1. Qualification

Institution Name

2. Qualification

Institution Name

3. Qualification

Institution Name

Canadian First Aid/CPR Certificate: Yes No
If yes, please list name of institution and Date of expiration

If no, are willing to take CPR/First aid course? Yes No
Canadian police check: Yes No
Full Canadian Driver's License: yes no

Legal Status

Open working permit:	Yes No N/A
Permanent Residence:	Yes No N/A
Landed Immigrant:	Yes No N/A
Canadian Citizen:	Yes No

Time lived/worked in Canada - since
Please, specify if needed

Employment Experience

Please, list in reversed chronological order.

Employer 1 (current or most recent)

Employer's Name

Position

Address

Live In
Live Out
Full Time
Part Time
Employer's Phone
Duties

Start Date
End Date
Reason for Leaving

Salary (Net)

Employer 2 (second most recent)

Employer's Name

Position

Address

Live In
Live Out
Full Time
Part Time
Employer's Phone
Duties

Start Date
End Date
Reason for Leaving

Salary (Net)

Employer 3 (third/last most recent)

Employer's Name

Position

Address

Live In
Live Out
Full Time
Part Time
Employer's Phone
Duties

Start Date
End Date
Reason for Leaving

Salary (Net)

Other Experience

Do you have newborn experience?
Yes No
Do you have any special needs experience?
Yes No
Do you have any elder/palliative care experience?
Yes No
If yes, please provide details

Any Other Related Experience? Please, provide details

Employment Preferences

What locations in Toronto would you consider to work in? e.g. Leaside

First Choice
Second Choice
Available to start

Full Time
Part Time

Please, specify options

Salary Expectation (Net): $ Week Day
Hourly rate: $

I am willing to do:

Laundry (Child’s/Elder's)
Laundry (Family's)
Ironing (Child's/Elder’s)
Ironing (Family's)
Cooking Child’s/Elder's)
Cooking (Family's)
Light Housekeeping (e.g. dusting, sweeping a floor)

Additional Information

Are you comfortable with pets? Yes No
Would you consider working for a single parent? Yes No
Would you consider nanny sharing? Yes No
Do you have children on your own? Yes No
What are your hobbies and interests?

What other and unique qualities and skills do you offer a family looking for a childcare giver or eldercare giver?

Communication skills and Languages

English:	Speak Write
French:	Speak Write
German:	Speak Write
Spanish:	Speak Write
Other:	(please specify)

Driving Information

Are you experienced driver? Yes No
Can you drive a standard transmission?
Automatic transmission?
Have you ever had your license suspended? Yes No