I. PERSONAL INFORMATION

*First Name *Lastname

Date of Birth Place of Birth

Age Sex Height Weight

Marital Status No.of Children Ages

Passport No. Date of Issue Day

Place of Issue Date

Years of Experience working as Nanny / Caregiver

For what position are you applying ?  

Live In: Full Time: Live Out: Full Time: Part Time:

Are you willing to work in: Rural Small Town City

Are you prepared to work: For a family where either parent works at home  

  ? For a single parent ?

II . ADDRESS INFORMATION

Present Address

Telephone Mobile email

Address of Country of Origin

III. EDUCATIONAL BACKGROUND

ELEMENTARY

Date Graduated

HIGHSCHOOL

Date Graduated

COLLEGE / TRADE SCHOOL

Date Graduated

DIPLOMA / CERTIFICATE

COURSE TAKEN

IV.EMPLOYMENT RECORD

1) Employer

Address

Tel.No. Length of Service

Number of Children / Elderly in care

Ages of Children / Elderly in care

Reason for Leaving

2) Employer

Address

Tel.No. Length of Service

Number of Children / Elderly in care

Ages of Children / Elderly in care

Reason for Leaving

3) Employer

Address

Tel.No. Length of Service

Number of Children / Elderly in care

Ages of Children / Elderly in care

Reason for Leaving

IV.EMPLOYMENT RECORD        

1. Are you experienced in:
a. Taking care of elderly or disabled persons?

b. Taking care of infants ( 0 - 6 months ) ?

1.Care of Infants
2.Feeding bottles to infants / babies
3.Changing diapers/clothing

c. Taking care of Babies / Toddlers (6 mos - 2 yrs) ?

1. Care of babies / toddlers
2.Prepare food & feeding babies / toddlers
3.Can you handle playgroup activities
4.Can you teach songs, nursery rhymes
5.Can you do housework while looking after children
6.5. Can you read bedtime stories

d. Taking care of Child ( 2 - 5 yrs ) ?

1. Prepare Nutritious Meal for the child / children
2. Teach how to read, write, colour, draw, count, share, be polite etc
3. Are you willing to take children on walks or to the playground
4. Are you patient dealing with tantrums / bad behavior

e. Taking Care of Child ( 5 - 10 yrs or over ) ?

1. Prepare Good Meal
2. Are you willing to take the child / children to Parks, Playgrounds, Pools
3. Do you know how to handle a child's temper
4. Are you willing to tutor the child or help him / her with homework 2. House Work
a. Do you know how to use ?
1. Microwave 2. VacuumCleaner 3. Blender 4. Dishwasher 5. Washer / Dryer 6. Coffee maker

b. Do you know how to cook ?
1. American / Western 2. Indian Food 3. Chinese 4. Italian / European 5. Mexican 6. Thai 5. Other Asian Food

c. Can you do ?
1. Laundry 2. Ironing 3. Vacuuming 4. Dusting 5. Gardening

d. Can you bake ?
1. Cookies 2. Bread 3. Cakes 4. Pies / Flans 5. Desserts

e. Can you take care of Pets ?
1. Dogs 2. Cats 3. Hamsters 4. Birds 5. Fish
6. Others ( Specify )

3. About Yourself

a. Can you do indoor - outdoor sports ?
1. Swim 2. Skate 3. Soccer
4. Tennis 5. Bike riding 6. Basketball
7. Volleyball 8. Table Tennis

b. Can you work flexible hours
c. Can you take care of the children without supervision
d. Can you babysit if parents require on your days off
e. Can you travel with employer's family if needed
f. Can you handle the children if parents need to be away for holidays
g. Have you suffered any serious injuries during the last five years

if yes, please specify the nature of injury

h. Have you suffered from any illnesses during the last two years

if yes, please specify the illness

i. Do you smoke?
j. Do you consume alcoholic beverages?
k. Have you ever been convicted of any crime?

if yes, what was the offence?

l. Do you have a recommendation from a previous employer?
m. Do you have a valid Driver's License
Place Issued ( City/ Country ) Expiration Date

n. Are you willing to sign for a 1 yr or 2 yr contract with the employer?
o. Do you have a work permit in Canada? Expiry date?

1.  Check activities you enjoy doing and capable of doing with children :

a. Art & colouring b. Walk & hike    c. Story telling   d. Reading books  

e.  Swimming       f.  Bike rides    g. Playing board games h. Puzzles  

i.  Crafts  j. Nursery rhymes  k. Tutoring    l. Outdoor sports

2. Grade yourself doing housework according to employer's satisfaction (previous / present employer)

a. General Housekeeping    b. Cooking   c. Laundry  c. Grocery / Shopping 

  d. Ironing   e. Gardening  f. Caring for Pets 

              E -  Excellent   VG -  Very   Good      G -  Good     A  -  Average     NE -  No  Experience

VII. FRIENDS AND RELATIVES IN CANADA

1) Name Contact No.

Relation

Address

2) Name Contact No.

Relation

Address

3) Name Contact No.

Relation

Address

 

VIII.     HOW /  WHERE DID YOU HEAR OF OUR AGENCY?

Friends       Phone Book  Ads        Referrals 
Remember to include with your resume package a letter to the family, introducing yourself.  Include information about your personal strengths, why you enjoy being a caregiver, and why you are looking forward to working in Canada.  Let your employer know what your future plans and goals are.  The purpose of the letter is to let your potential future employer know more about you on a personal level.  Take time to review your letter, checking spelling and grammar.
STATEMENT OF DISCLOSURE 
I hereby certify that all information on this application and all documents provided to HELPING HANDS INTERNATIONAL PERSONNEL NANNIES & CAREGIVERS AGENCY is true and accurate. I understand that any inaccurate or misleading information is cause for immediate termination of the contract.
I understand as well, that any position I accept through Helping Hands International
Personnel  Nannies & Caregivers Agency will involve deductions of income tax,  employment insurance  and Canada Pension Plan by the employer, as required by
Canadian law.

Name:   Date: