EMPLOYER ORDER FORM TO HELP US SERVE YOU BETTER PLEASE FILL OUT ORDER FORM.  DEPENDING ON THE TYPE OF IN-CARE YOU ARE HIRING, SOME OF THE QUESTIONS MAY NOT APPLY.

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Family Name:                                                        First Name:

Address:                                                                  

City:                                                 Province:                        Postal Code:

Home Phone:                                                          Fax No:                                              

Work Phone:                                                           Fax No:       

Spouse Name:                                                        Phone:

Email Address:   

Best Time To Contact You:   

Best Way To Contact You:

WHAT TYPE OF CAREGIVER ARE HIRING  

Live-in Hire from Overseas[______]          Live-in Hire Locally[______]             Full-time Live-out [______]

DURATION OF EMPLOYMENT

One Year[______]                           Two Years[______]                     More Than two Years[______] 

DETAILS OF INDIVIDUALS TO BE CARED FOR ARE AS FOLLOWS:

 Name

Age

Relationship

Schedule

WHAT ARE THE DUTIES OF THE CAREGIVER? AS WELL, IS THE CAREGIVER REQUIRED TO ESCORT THE ABOVE-MENTIONED INDIVIDUAL (S) TO SCHOOL, MEDICAL APPOINTMENTS, LESSONS ETC.?

Drivers' Licence Required:        Yes[_____]    No[_____]          

Caregiver First Day Of Work: 

IS CARE REQUIRED DUE TO ANY BEHAVIOURAL OR HEALTH PROBLEMS:  IF YES, DESCRIBE BRIEFLY.

WILL CAREGIVER BE SUPERVISED IN THE HOME: IF YES, PLEASE EXPLAIN:
 
 

WAGES AND WORKING CONDITIONS

Monthly Net Wage: $                                 Overtime Hours Paid Extra:  Yes[_____]    No[_____]           

Hours Per Day:

Daily Schedule Start:

Hours Per Week:

Days Off:

IS SPLIT HOURS INVOLVED? IF YES, PLEASE PROVIDE DETAILS: 

PLEASE PROVIDE A DESCRIPTION OF EMPLOYEE'S PRIVATE ACCOMMODATION, IF LIVE-IN:

Furnished Room:  Yes[_____]    No[_____]             / Door Lock Provided:   Yes[_____]    No[_____]   

When Do You Like To Start Interviewing:

I Heard About NFDA Through: