EMC Caregivers Canada - Caregiver Application

* These are required fields.

Personal Information:

First Name*:

Last Name*:

Current Address*:

Current Province:

Current Country*:

Current Postal Code:

Home Phone Number*:

Work Phone Number:

Email Address*:

If you wish NOT to be contacted at your current place of work, please provide an alternate phone number:

Best time to contact you*:

Who can we contact, in case you change employers and we are unable to contact you?:

Date of Birth*:

Country of Birth*:

Nationality*:

Religion*:

Marital Status*:

Number of own children:

Ages of your children:

Do you speak fluent English?*:

Other languages spoken (please, state degree of fluency):

Mother's Occupation:

Father's Occupation:

Do you have brothers or sisters?:

Do you have any health conditions that may prevent you from doing the essential duties of your job?:

Are you on a special diet?:

Do you have any serious allergies?:

Do you smoke?:

Do you drink alcohol?:

Do you swim?:

Do you play any musical instruments?:

Please list your interests and/or hobbies*:

Do you have a valid Driver's License?:

Do you have an International Driver's License?:

Preference in Location:

Do you have a preferred location in Canada?:

Education:

Year of Graduation from College/University:

College/University Name:

Degree/Diploma Achieved:

Subject of Study:

Please list any additional education:

Please list any child-related training:

Do you have 6-month full-time caregiver training in a classroom setting?:

Are you certified to perform CPR?:

Are you certified to perform First Aid?:

Please list any other courses taken:

Employment History:

Please list your last job(s), beginning with the most recent (up to 3):

1. Add Recent Job:

Employer's name:

Your Position:

Start date of employment:

Finish date:

Still currently employed?:

Number of children:

Age(s) of the children when started:

Responsibilities:

Reason For Leaving:

2. Add More Job:

Childcare Experience:

Years working with Special Needs Children:

Total number of years of experience as a nanny:

Do you have experience with the following ages? (Check all that apply):

Do you have at least 12 months of experience in paid employment as a child caregiver, obtained within the last 3 years, excluding work for relatives?:

Are you willing to care for a Special Needs Child?:

Housekeeping Duties:

Which duties are you willing to do? (Check all that apply):

Do you enjoy cooking?:

Do you have any objection to pets in the home?:

Elderly Care:

Do you have paid experience looking after the elderly?:

Have you worked as a caregiver for the elderly within the last three years?:

Additional Details:

Please, explain why you will make a good caregiver:

Do you have any friends or relatives working or residing in Canada? Please give names, locations and phone numbers:

Please, share any comments that you think would be helpful to us:

for families

for caregivers

For Families

Caregiver Application Form

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