English French Spanish Russia
Cantonese Italian German Greek
Mandarin Swedish Portuguese Finnish
Tagalog Arabic Ukrainian Hebrew
Punjabi Polish Japanese Hindi
Other
How would you rate your English language skill ... ?
bad
poor
average
fair
good
How would you rate your French language skill... ?
bad
poor
average
fair
good
How would you rate your Cantonese language skill... ?
bad
poor
average
fair
good
How would you rate your Mandarin language skill... ?
bad
poor
average
fair
good
EDUCATIONAL INFORMATION:
College/University:?
Years in
College/University?
Degree/Diploma in what?
Other
Training/Certificate
How many year in total of nanny/housekeeper Experience
Enter # of Kids you're willing to care for at a time
QUESTIONER NEEDS YES OR NO
ANSWER EXCEPT # 32 AND UP
1
How many
years in total of nanny/childcare working experience
2
Number of children you're
willing to care for at a time?
3
Are you
able to care for all age group?
3b
"If no"
what
ages are you must capable?
4
Can you work for a single parent?
5
Can you work flexible schedule?
6
Will you work overtime if paid
extra?
7
Earliest month and year
available to work In Canada?
8
Can you sign a minimum 2 years working
contract?
9
How many years maximum, can you sign
"if" great working conditions?
10
Have you taken any first Aid/CPR
course?
10b
"if no" are you willing to take a one
day course needed within a month of your arrival in Canada? Employers
feel safe &comfortable if you have first aid training.
11
Can you travel with employing family
"if" needed?
12
Do you have a driver’s license?
12b
If “yes” any accidents or
violations?
12c
"if no"Are you willing to learn&become
a driver if possible?
13
Can you swim?
14
Do you smoke?
15
Do you drink
alcohol?
16
Do you suffer from allergy ?
17
Have you ever suffered from infectious
disease?
18
Do you suffer from any physical
defects?
19
Have you undergone any surgery over
last 24 months?
20
"if no"any pending surgery you're aware
of inthe next 5 years?
21
Have you committed any criminal
offence?
22
Ever been accused of THEFT by
previous employer or anyone?
22b
"if yes"by whom?
23
Do you attend church
weekly?
23b
"if yes"How many time a week?
24
Do you enjoy reading &
play with young children?
25
Are you able to tutoring & do
home workwith children if/when required?
26
Do you enjoy taking
children to the park for playtime on a nice day?
27
Are you willing to walk kids to
school-if /when required?
28
Are you able & willing to help toilet trained toddler- if/when
required?
29
Are you able & willing to Change baby's diapers?
30
Are you able & willing to care for a sick child when parent not at
home?
31
Are you able & willing to take children to after school activities-
if/when required?
32
How organized are you?
-scale of 1 to 5?
33
How good is your general
housekeeper skill?-scale of 1 to 5 ?
34
How good is your English language
skill?-scale of 1 to 5 ?
35
How good is your French language
skill?-scale of 1 to 5 ?
36
How good is your Cantonese language skill?-scale of 1 to 5
37
How good is your Mandarin language skill?- scale of 1 to 5 ?
38
How great is your cooking? - scale
of 1 to 5 ?
39
What type of cooking you
best at:
40
"If you don't cook-who does your
cooking now ?
41
Are you open& willing to
getting hired anywhere in Canada?
41b
"if no" why & where is
your Prefer location:
42
Do you have Friends/Relatives in Canada?
42b
'if yes" where?
& How many?
43
Do you have written
references from previous employer (s)or current employer? "if yes,
copies must be included with this resume to NFDA Canada.
43b
"if no"why?
44
Most Canadian families have house
pets-Are you afraid of pets?
44b
if yes" List type of pets
are you're most afraid:
45
Also, List pets you're willing to work
in a home:
46
Can you be left alone with children
"if/when" employer go on a short trip?
47
"If no" why?
DETAILED WORKING EXPERIENCES-FIRST EMPLOYMENT:
Location & Position
From when -Till
# of Persons in your care
List their ages
Reason for leaving
Employer's name
Employer's
Contact #
Will not contact employer without
your consent
In Brief- Describe your
daily duties/responsibility
DETAILED WORKING EXPERIENCES-SECOND EMPLOYMENT:
Location & Position
From when -Till
# of Persons in your care
List their ages
Reason for leaving
Employer's name
Employer's
Contact #
Will not contact employer without
your consent
In Brief- Describe your
daily duties/responsibility
DETAILED WORKING EXPERIENCES-THIRD EMPLOYMENT:
Location & Position
From when -Till
# of Persons in your care
List their ages
Reason for leaving
Employer's name
Employer's
Contact #
Will not contact employer without
your consent
In Brief- Describe your
daily duties/responsibility
DETAILED WORKING EXPERIENCES-CURRENT EMPLOYMENT:
Location & Position
From when -Till
# of Persons in your care
List their ages
Reason for leaving
Employer's name
Employer's
Contact #
Will not contact employer without
your consent
In Brief- Describe your
daily duties/responsibility
Can we contact employer for for verbal references?
“ NO” why?
Caregiver
Contact/Mailing information
Full
Name
Street Address
City
Country
Work PhoneHome Phone
Cell Phone
Fax
E-mailEmail
Note: if your email if
wrong, you will not hear from us so,
make sure your email is
completely enter.
PLEASE PROVIDE
INFORMATION OF YOUR EXTENDED FAMILY:
Full Name
How is this person
related to you?
Street Address
Country
Work Phone
Home Phone
Fax
CAREGIVER FAMILY/FRIENDS IN CANADA
INFORMATION
Full Name
Full Address
profession
Home Phone
Cell/ work
Second
Family/Friend in Canada
Full Name
Full Address
profession
Home Phone
Cell/ work
Third
Family/Friend in Canada
Full Name
Full Address
profession
Home Phone
Cell/ work
How did you hear about
NFDA Canada:
DISCLOSURE
I _______________________________________________ I understand that
all information supplied during my application process are true and
compete to the best of my knowledge that any misrepresentation or
omission of facts may be sufficient cause, in and of itself, for
rejection or dismissal whenever discovered. I understand that any job
I accept through NFDA Canada
will involve the deduction of income tax, unemployment insurance
benefits and Canada Pension as recommend by Canadian law and that I
become the employee of the family that hire me and not the employee of
NFDA Canada. I understand that I
will not accept a position with employers without first notifying
NFDA Canada I solemnly
swear that information I have given is correct.
