Full Name:
SIN:
Address:
City :
Province :
Postal Code:
Email address:
Home Phone #:
Work Phone #:
Fax #:
Date of Birth:
Place of birth:
Education:
Special Training:
Languages:
Drivers License:	YES NO
Smoker :	YES NO

Employment History and working experience

Employer's Name:
Where:
How long:

Employer's Name:
Where:
How long:

Experience in caregiving:
Describe yourself as a caregiver:

Position seeking:	Nanny Housekeeper Personal Care Other
When can you start:
	Live-in Live-out
	Permanent Temporary

References

Name:
Number: (include area code)
Name:
Number: (include area code)
Name:
Number: (include area code)
Name:
Number: (include area code)

Specific Job Information

Geographic area preferred:(list as many as you wish)
Seeking salary range of:
Have you worked with children before?	YES NO
Age of children you have previously cared for:
Age of children you would like to care for:
How many children have you cared for at given one time:
Would you work in a single parent house?	YES NO
Are you willing to do housework?	YES NO
Do you cook?	YES NO
Rate your cooking:	Good Excellent
Do you like pets?	YES NO
Do you have any experience with handicapped or special needs children or people?	YES NO
If yes, please explain...
Can you swim?	YES NO
Hobbies/Activities:

I hereby, certify that all of the information in this application is accurate to the best of my knowledge. I understand that false information is grounds for immediate dismissal from employment.
Agree	Disagree

2783 W 35th Ave, Vancouver. BC. Canada, V6N 2M1 Contact us