Edmonton Nanny | Nanny Calgary | Nanny Toronto | Nanny services in Edmonton, Toronto and Calgary Nanny | Preferred Personnel of Canada Inc

If you would like to hire an special needs caregiver, please fill out our Special Needs Application Form below

If you have questions, please contact us and we will be happy to assist you.

Salutation

First Name

Last Name

City

State/Province

Title

Phone

Mobile

Fax

Street

Postal Code

Country

Marital Status

Email Opt Out

Fax Opt Out

Do Not Call

Lead Record Type

Have you previously hired a caregiver?:

Additional help employed (cleaning, etc)

Appliances to be used

Average hours of work per day

Concerns, diet, allergies, disabilities

Days off per week (SatSunFlex)

Description of caregiver's duties

Description of home (Size, # of rooms)

Distance to Public Transportation

Distance to Shopping

Is Your Home Urban, Suburban, or Rural?

Is a driver required for this position?

Is this a smoke-free environment?

Languages spoken in home (Eng/Fr/Other)?

Medical Information

Monthly Salary

Other persons in home?

Are there any pets in the home?

Please describe any pets in the home

Type of care required for your pet

Do you have a Revenue Canada business number for a Domestic Helper?

Revenue Canada Business Number

Room and Board Charge

Size of home

Type of accommodation provided

When is help required?

Who did you find helpful at preferred?

How did you hear about Preferred Personnel?

Will an insured vehicle be provided?

Will caregiver require her own vehicle?

Work Day End Time

Work Day Start Time

Who is now responsible for their care

Hire a Caregiver For Special Needs Care