Live-In Caregiver Application


Personal Information

E-mail Address: *
Name:
Mailing address:
Phone Number:
Best time to contact you:
Age:
Date of birth:
Country of birth:
Nationality:
Marital status:
Any children? If so, what are their ages?
Number of brothers or sisters:
Oldest? Youngest?
Date available to start in Canada:
Will you come directly to Canada to start employment?YesNo
Are you planning to go home first?YesNo
If yes, for how long?
Please provide name and phone number for any family/friends in the Calgary area:

Education/Training

High school completed:YesNo
Date of completion:
College/University - year of graduation:
Type of degree:
Length of program:
Completed 6-month childcare course:YesNo
Date of completion:
Other training/date of completion:

Work Experience

How many years of child care experience do you have?
How many years of elderly care experience do you have?
Do you have experience with special needs children?YesNo
If so, please describe the care you provided:
Please indicate the age groups you have provided care for as a hired caregiver (not including own children/ relatives):0 - 9 months
9 - 12 months
12 - 18 months
18 months - 2 years
2 - 3 years
3 - 5 years
6+ years
Number of children you have cared for at one time:
Will you provide special needs care?YesNo
Will you provide elderly care?YesNo
Number(#) of years in Hong Kong:
Other countries worked in/number of years:
Number of employment contracts:
Total number of families you have worked for:

Summary of employment history

Most recent employment contract:
Location:
Start/end date:
Number of children:
Ages (starting at):
Reason for leaving:
Previous employment contract:
Location:
Start/end date:
Number of children:
Ages (starting at):
Reason for leaving:
Previous employment contract:
Location:
Start/end date:
Number of children:
Ages (starting at):
Reason for leaving:
Previous employment contract:
Location:
Start/end date:
Number of children:
Ages (starting at):
Reason for leaving:
Previous employment contract:
Location:
Start/end date:
Number of children:
Ages (starting at):
Reason for leaving:
Previous employment contract:
Location:
Start/end date:
Number of children:
Ages (starting at):
Reason for leaving:


What type of duties did you perform as a domestic helper? *

Caregiver Details

Are you willing to sign a one-year contract?YesNo
Two-year contract?YesNo
Are you willing to work flexible hours/evenings and weekends?YesNo
Shift work?YesNo
Will you work overtime, if compensated?YesNo
Will you travel with the family?YesNo
Have you taken a CPR and/ or First Aid course?YesNo
If so, date completed:
Will you attend a CPR and/ or First Aid course in Canada?YesNo
Do you have a valid drivers license?YesNo
If yes – any accidents or violations?
Do you smoke?YesNo
Do you consume alcohol?YesNo
Can you swim?YesNo
Do you play any musical instruments? If so, which ones?
Are you willing to work in a rural area?YesNo
On a farm?YesNo
Are you willing to plan and/or prepare meals?YesNo
Please describe your cooking experience and interest:
Have you taken care of pets before? If so, what types of pets?
Are you willing to take care of pets?YesNo
If so:WalkingGroomingFeeding

Caregiver Requirements

Please provide 3 – 5 qualities you are looking for in an Employer/ Family (for example: smoke free, outdoors, quiet):

Caregiver Personality Information

Describe what you like to do for hobbies/ fun:
Please explain why you would make a good caregiver:
Why do you want to work in Canada?
What do you plan to do once you have completed the 24-month Live-In Caregiver Program?
What is the longest period you have been away from home?
Have you ever left a job to go back home?
What do the children you care for think of you?
What did your last employer like best about you?
What do you like least about your job?
Please provide a short summary letter describing yourself to your potential employer:
How did you hear about the Nanny Connection? If you heard about the Nanny Connection from a friend or co-worker, please list their name.
A confirmation will be sent to your e-mail address.
We thank you for applying at the Nanny Connection!
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