Family Application Form

Find a Nanny or Caregiver

* Denotes required field

Basic Details


*Name
*Address
Apt/Suite
*City
*Province
*Postal Code
*Email
*Phone (Home)
Phone (Cell/Mobile)
Fax
Main Intersection
Nearest Subway Station
Do both parents reside with children?	Yes No
If no, please specify	Mother Father

Mother's Info


Name
Occupation
Email
Work Phone
Cell (Mobile) Phone

Father's Info


Name
Occupation
Email
Work Phone
Cell (Mobile) Phone

Children's/Elder's/Special Needs Person

Name Age
Name Age
Name Age
Name Age
Name Age

Job Description

Start Date
Live In
Live Out
Full Time
Part Time

Position (please select)

Nanny/House Manager
Nanny/Housekeeper
Housekeeper/Assistant
Elder Caregiver/Housekeeper
Start Time (a.m.)
End Time (p.m.)

Expect to pay

Net per hour $
Gross per week $
Gross per month $

Expected Duties

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)
Any other tasks (e.g. administering a medication)? (Please specify)

Driving/Vehicles

Driver Required? Yes No
Transmission
Standard transmission?
Automatic transmission?

Vacations

Paid Vacations? (Please describe)

Unpaid Vacations/Sick Days? (Please describe)

Is the nanny/caregiver/assistant expected to accompany family/elder holidays? Yes No
If yes, where and how often? (Please describe)

Ideal Candidate

Qualifications required (e.g. E.C.E. diploma, Health Care Aid, Nursing background, First Aid/CPR)?

Previous Experience

Language Preference? (Please specify)

Swimmer Required? Yes No

Any other specific requirements? (Please describe)

Accommodation for nanny/caregiver

Is there accommodation for nanny/caregiver? Yes No

If yes, please describe

Private Basement
Shared Basement
Television
VCR/DVD
House Phone
Private Phone Line
Other Amenities