Select Nannies - For Nannies - Caregiver Application Form

Welcome to our online Caregiver Application form. Please fill in the fields below as completely and as accurately as you can. Thank-you.

* - indicates a required field

PERSONAL INFORMATION:

*Your First Name:		Your Middle Name:
*Your Last Name:
*Current Address:		*Current City:
Current Postal:		*Current Country:
*Home Phone:		Work Phone:
Email Address:		*Best time to contact you:
If you wish NOT to be contacted at your current place of work, please provide an alternate phone number:
Who can we contact, in case you change employers and we are unable to contact you?

*Date of Birth:
Country of Birth:
Nationality:	If other, explain:
Religion:
Age:		Marital Status:
*Height:		Number of own children:
*Weight:		Ages of your Children:
Speak fluent English?
Other languages spoken (please, state degree of fluency):
Mother's Occupation:		Father's Occupation:

Do you have brothers or sisters?
If Yes, please give their ages:
Do you have any health conditions that may prevent you from doing the essential duties of your job?
If yes, please explain:
Are you on a special diet?
If yes, please explain:
Do you have any serious allergies?
If yes, please explain:
Do you smoke?
Do you drink alcohol?
Do you swim?
If yes, how well do you swim?
Do you play any musical instruments?
If yes, please list:
*Please list your interests and/or hobbies:
Do you have a valid Driver's License?
Do you have an International Driver's License?

PREFERENCE IN LOCATION:
Do you have a preferred location in Canada? If yes, list locations:

EDUCATION:
Year of Graduation:		College/University Name:
Diploma Achieved:		Subject of Study:

Please list any additional education:
Please list any Child-related training:
Do you have 6-month full-time caregiver training in a classroom setting?
Are you certified to perform CPR?
Are you certified to perform First Aid?
Please list any other courses taken:

LAST DAY IN CURRENT COUNTRY:
What is the Caregiver's last day till which she can remain in the current country, if any?:

EMPLOYMENT HISTORY:
Please list your last three jobs, beginning with the most recent:
Job 1.	Employer's name:
	Your Position:
	Start date of employment:
	Finish date:	Still currently employed
	Number of children:
	Age(s) of the children when started:
	Responsibilities:	Childcare duties Cooking for children only Cooking for the family Homework tutoring Accompanying children to activities Drive children to activities Full housekeeping Light housekeeping only Family laundry Children's laundry only Ironing Pet Care Other
	Reason For Leaving:
Job 2.	Employer's name:
	Your Position:
	Start date of employment:
	Finish date:	Still currently employed
	Number of children:
	Age(s) of the children when started:
	Responsibilities:	Childcare duties Cooking for children only Cooking for the family Homework tutoring Accompanying children to activities Drive children to activities Full housekeeping Light housekeeping only Family laundry Children's laundry only Ironing Pet Care Other
	Reason For Leaving:
Job 3.	Employer's name:
	Your Position:
	Start date of employment:
	Finish date:	Still currently employed
	Number of children:
	Age(s) of the children when started:
	Responsibilities:	Childcare duties Cooking for children only Cooking for the family Homework tutoring Accompanying children to activities Drive children to activities Full housekeeping Light housekeeping only Family laundry Children's laundry only Ironing Pet Care Other
	Reason For Leaving:

CHILDCARE EXPERIENCE:
Please indicate how many years experience you have for the following:
Work with Special Needs Children:
Total number of years of experience as a nanny:
Do you have experience with the following ages:
Newborn:		3-24 Months:
2-5 Years:		6-12 Years:
Do you have at least 12 months of experience in paid employment as a child caregiver, obtained within the last 3 years, excluding work for relatives?
Are you willing to care for a Special Needs Child?

HOUSEKEEPING DUTIES:
Check off all the duties that you are willing to do:
	Perform light housekeeping only	Perform full housekeeping
	Do family laundry	Run errands
	Prepare meals for the family	Prepare Children's meals only
	Drive children to school	Pet care
Do you enjoy cooking?
How would you rate your cooking skills:
Do you have any objection to pets in the home?
If yes, please explain:

ELDERLY CARE:
Do you have paid experience looking after the elderly?
If yes, how many years?
Have you worked as a caregiver for the elderly within the last three years?
Describe your experience (age and condition of the person, etc):
Responsibilities:	Eldercare duties Cooking for the elder(s) Cooking for the family Monitoring of Vital signs Bed bathing Administering of Medication Accompanying elder(s) to appointments Drive elder(s) to appointments Full housekeeping Light housekeeping only Family laundry Elder(s)' laundry Ironing Pet Care Other

PLEASE ANSWER THESE QUESTIONS FOR OUR AGENCY:

Please, explain why you will make a good Caregiver:

Do you have any friends or relatives working or residing in Canada?
Please give names, locations and phone numbers:

Please, share any comments that you think would be helpful to us:

TERMS & CONDITIONS: (click here to view the Terms & Conditions)

By checking the check-box on the left and clicking on the "Send Application" button below, I hereby certify that the information provided on the above Caregiver Application form is true. I also certify that I have read, understand and agree to be bound by the Terms and Conditions which also form part of this Application. In order to activate my online application with Select Nannies Inc., I will need to forward the required Supporting Documents to Select Nannies Inc. in the next three months, or I will be removed from the database.

I understand that Select Nannies Inc. will not charge me any fees at any time and I agree not to pay any recruitment fees to any other third party in Canada in overseas. I may chose to hire an independent licensed immigration consultant for a fee to assist me with the processing of my work permit to Canada. I understand that my future employer in Canada is responsible for the payment of my transportation, including a one-way ticket from my country of permanent residence or of current residence to the place of work in Canada. It will be my responsibility to pay for medical exam expenses and the processing fee of $150 to the Canadian Embassy.

If you are satisfied with the information you entered above, please click the "Send Application" button below to send your application directly to us. We will respond within 24 hours.

Your information will be kept private and confidential, and is for our internal use only. For more information on the privacy of your information please review our Privacy Policy.