Local Childcare Nanny Application Form (Live-In)

Nanny/Caregiver Contact Information

Full Name *

Email *

Phone Number *

Current Address *

Age *

Date of Birth *

Place of Birth *

Marital Status

Do you have any family at your desired location of employment?YesNo

LCP (live-in Nanny program, if applicable)

Arrival Date

Work Permit Expiry

Months Employed on Live-In Program (according to ROE)

Education

High School (Year Completed)

Post Secondary (Institution Name, Year Completed, Degree Obtained)

Childcare/Eldercare Training Courses

First Aid/CPR Certification Dates

Additional Education

Employee Information

Infant Care Experience

Toddler Care Experience

Preschool Care Experience

Have you cared for children aged 3 – 5 years old?YesNo

Describe what learning activities you would do with a preschooler (3-5)

Are you familiar with the normal stages of development of preschool aged children?Proper nutritionSleep pattern/ required amount of sleepGross motor skillsFine motor skillsAppropriate play

What outdoor activities would you do with children?

School Age Care Experience

Have you cared for Children aged 5-12 years old?YesNo

If you have cared for children between the ages of 5 and 12, what activities did you involve the child in to help keep her active and occupied?

Would you be able to assist a child with homework?YesNo

Have you cared for Teenagers?YesNo

Do you feel you could manage and direct a teenager?YesNo

Domestic Experience

Canadian Employment Experience

Name of Employer 1

Email of Employer 1

Phone number of Employer 1

Address of Employer 1

Start Date of Employment

Left Date of Employment

Will you use this employer as a reference?YesNo

Have you had problems with this employer?YesNo

If yes, please describe:

Detailed Job Description (Please list all tasks and duties that you completed in the home on a daily basis. Include children’s age(s) and gender, housekeeping duties, play activities, etc.):

Reason for leaving:

Canadian Employment Experience (2)

Name of Employer 2

Email of Employer 2

Phone number of Employer 2

Address of Employer 2

Start Date of Employment

Left Date of Employment

Will you use this employer as a reference?YesNo

Have you had problems with this employer?YesNo

If yes, please describe:

Detailed Job Description (Please list all tasks and duties that you completed in the home on a daily basis. Include children’s age(s) and gender, housekeeping duties, play activities, etc.):

Reason for leaving:

International Employment Experience (if applicable)

Name of Employer

Email of Employer

Phone number of Employer

Address of Employer

Start Date of Employment

Left Date of Employment

Will you use this employer as a reference?YesNo

Have you had problems with this employer?YesNo

If yes, please describe:

Detailed Job Description (Please list all tasks and duties that you completed in the home on a daily basis. Include children’s age(s) and gender, housekeeping duties, play activities, etc.):

Reason for leaving:

Personal Information

Do you need time off to attend religious services? If yes, when?:

What are your hobbies and interests?

What languages do you speak?

Do you smoke?YesNo

Do you drink?YesNo

Can you swim?YesNo

What activities do you enjoy?

What are your future goals?

What would you like potential employers to know about you? (This is your area to shine, to really give your future employers a window of whom you truly are. Please list information about

I hereby agree that I will:

Supply factual, truthful, and complete required information to Preferred Personnel
Provide references and contact information of current/past employers for employment authentication
Be confidential about employers and families personal information
Be available by phone or email to Preferred Personnel and potential employers. No contact results in no employment
Be punctual for interviews with employers
Be courteous and cancel an interview with potential employers with sufficient notice by directly contacting the employer by telephone
Be in contact with Preferred within 24 hours of interview with an employer

I agree to Preferred Personnel’s Code of EthicsAgree

I agree to provide Preferred Personnel with personal information which will be shared with potential employers in order to assist me in finding employment.Agree

Preferred Personnel will on your behalf at no cost:

Find an appropriate and good employer for you.
Prepare and consult on changes for your work permit in Canada.
Assist with any concerns, or questions regarding employment or immigration.
Provide ongoing support.
Assist in any labour disputes.