INFORMATION PROVIDED MUST BE TRUTHFUL & ACCURATE. 

One (1) year minimum Position Only.

   Live-In Nanny: ________          Live-In Nanny/Housekeeper:     ________          Live-In Elderly care:    ________   

Live-Out Nanny: ________       Live-Out Nanny/Housekeeper:   ________         Live-Out Elderly care:   ______

A.                 PERSONAL INFORMATION (Please write clearly & IN BLOCK LETTERS) 

First Name: __________________________________________ Surname ____________________________________________

 Age: ____________ Nationality: _________________________________ Height: ____________ Weight: _______________

Sex:_______________________Social Insurance Number:________________________________________________________

Marital Status: ________________________________ Any Children: ___________ Ages: _____________________________

Date of Birth:  _______________________ Passport No: _________________________ Expiry:  D_____ M ______Y______

College/University Diploma: _________________________________________________________________________________

Other Training:_____________________________________________________________________________________________

Arrived Canada:_______________________ Day _________________________ Month  ___________________________Year

LANGUAGES UNDERSTAND  &  SPOKEN:  English[  ]  French[  ] Cantonese[  ]   Mandarin[  ]  Spanish[  ]  German[  ] 

Russia[  ]  Arabic[  ]   Greek[  ]     Japanese[  ]     Italian[  ]  Hebrew[  ] 

B.                  CURRENT ADDRESS INFORMATION

Your Present Address:    ___________________________________________________________________________________

Tel: _____________________________________________ Cell:    __________________________________________________

Fax: __________________________________________ Email:  _____________________________________________________

Earliest Date Available To Work New Position:   _______________________________________________________________

Date Arrived in Canada: ____________________________________________________________________________________

C.                 WORKING EXPERIENCE

[FIRST] Name of Employer: _____________________________________________ Country (Location):  ________________

From: Day_________ Month _________ Year ___________ till:  Day__________ Month___________ Year   ____________

No. Person(s) In-care: ____________________ Ages: ____________________________________________________________

Main Duties: _______________________________________________________________________________________________

Why You Left / You Want To Leave: _________________________________________________________________________

Employer Telephone #:_____________________________________________________________________________________

[SECOND] Name of Employer: ___________________________________________ Country (Location):  ________________

From: Day_________ Month _________ Year __________ till:  Day__________ Month___________ Year   _____________

No. Person(s) In-care: ____________________ Ages: ___________________________________________________________

Main Duties: ______________________________________________________________________________________________

Why You Left / You Want To Leave: ________________________________________________________________________

Employer Telephone #:_____________________________________________________________________________________

[THIRD] Name of Employer: _____________________________________________ Country (Location):  ________________

From: Day_________ Month _________ Year ___________ till:  Day_________ Month___________ Year   _____________

No. Person(s) In-care: ____________________ Ages: ___________________________________________________________

Main Duties: ______________________________________________________________________________________________

Why You Left / You Want To Leave: ________________________________________________________________________

Employer Telephone #:_____________________________________________________________________________________

[PRESENT] Name of Employer: ___________________________________________ Country (Location):  _______________

From: Day_________ Month _________ Year ___________ till:  Day__________ Month___________ Year   ___________

No. Person(s) In-care: ____________________ Ages: ___________________________________________________________

Main Duties: ______________________________________________________________________________________________

Why You Left / You Want To Leave: ________________________________________________________________________

Employer Telephone #:____________________________________________________________________________________

>>>IF YOU HAVE MORE EMPLOYERS PLEASE ATTACH IN SEPARATE SHEET<<<

D.QUESTIONNAIRE (Enter Yes or No were applicable)

1. How many years of childcare in total?                                                  -------------------------------------------------------

2. How many years of elderly/Disable care in total?                                   -------------------------------------------------------

3. Can you care for any age group of children: _____ “If not” ages you are must capable:            -------------------------

3a.How many children are you willing and or able to care?                    ------------------------------------------------------------

4. Can you work flexible schedule:                                                       ----------------------------------------------------------

5. Can you work overtime if paid:                                                         ----------------------------------------------------------

6. Can you sign 1 year working contract:                                                      --------------------------------------------------

7. Can you sign 2 years working contract:                                           ------------------------------------------------------------

8. Have you taken any first aid course?                                                     ------------------------------------------------------

9. Can you swim?                                                                             ------------------------------------------------------------

10. Do you have a driver’s license?                                                         --------------------------------------------------------

12. Your driver’s license #                                                                ------------------------------------------------------------

13. If “yes” any accidents or violations?                                              ------------------------------------------------------------

14. Can you travel with employing family if needed?                               -----------------------------------------------------------

15. Can you work for a single parent?                                                 ------------------------------------------------------------

16. Do you smoke?                                                                            -----------------------------------------------------------

17. Do you consume alcoholic drinks?                                                 ------------------------------------------------------------

18. Are you afraid of dogs, other pets?                                               ------------------------------------------------------------

19. Do you suffer from allergy of any kinds?                                          -----------------------------------------------------------

20. Have you ever suffered from any infectious disease?                       -------------------------------------------------------------

21. Have you ever committed any criminal offence ever?                       ------------------------------------------------------------

22. Hobbies / Interests?                                 -----------------------------------------------------------------------------------------------

23. Ever been accused of theft by previous employer?                         -------------------------------------------------------------

24. Desired salary if Childcare?                                          $ -------------------------Max $  ---------------------------------------

25. Desired Salary if Elderly or Disabled Care?                                     ------------------------------------------------------------

E.                  BRIEF QUESTIONS:    CHILDREN: [Give details below on your experience & capability]

(From newborn to 13 years old)   .___________________________________________________________________________

__________________________________________________________________________________________________________

CHILDREN’S ACTIVITIES & DOMESTIC DUTIES [Check below your experience & capability]

Able to manage childcare & household chores   Tutoring   Cooking   

Drop off & pick-Up from school “if No” what can you do:            -          ------------------------------------------------

ELDERLY OR DISABLE: [Give full details below on your experience & capability]_________________________________

______________________________________________________________________________________________________

Specific Medical Condition you experience with:   ___________________________________________________________

PREFERRED EMPLOYMENT LOCATION:

Vancouver/Richmond  Burnaby/Surrey    White Rock/ Langley Coquitlam/Port Coquitlam 

Port Moody  Abbottsford   New Westminster   Tsawwassen/Ladner   West/North Vancouver   

Maple Ridge Mission    Chilliwack    Squamish Valley

List Other Areas:  ___________________________________________________________OR Anywhere in Canada

_______________________________________________    /           ________________________________________

How did you hear of this agency?                                            Registration Date

DISCLOSURE

I _______________________________________________ hereby authorize those statements/references investigate without liability arising therefore.  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 NannyFinders Directory Agency Canada Ltd will involve the deduction of income tax, unemployment insurance benefits and Canada Pension and that I become the employee of the family that hire me and not the employee of NannyFinders Directory Agency Canada Ltd.  I understand that I will not accept a position with employers without first notifying NannyFinders Directory Agency Canada Ltd...   I solemnly swear that information I have given is correct.

Print Name:  ________________________________________Sign: __________________________________________

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Website: www.nannyfindersbc.com    Email us: hire@nannyfindersbc.com

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