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Personal Information of Caregiver


Name:
Sin:
Address:
City:
Country:
Telephone Number:
Country of Origin:
Birthdate:
Immigration Status:
Marital Status: MarriedSingle
Do you have children? YesNo
If Yes, Names and Ages:
Date available for employment:
Expected Salary:
What position are you looking for? Full TimePart Time
If part time, days and hours:
What locations are you willing to work?
What languages do you speak?
Do you have a criminal record? YesNo
Do you have a drivers license? YesNo
How long have you been driving?
Can you drive a standard? YesNo
Do you own a car? YesNo
Do you smoke? YesNo
Any Allergies? If yes, please describe.
Are you willing to work for a family that includes a smoker? YesNo
List any hobbies or interests:
Health Condition:
Are you willing to work in a home with pets? YesNo
Are you willing to pay for your airfare to/from Canada? YesNo
How much notice of termination do you have to give to present employer?
Number and ages of children you are willing to work for:
List the housework you are willing to do:
Not willing to do:
Are you willing to prepare meals? YesNo
Are you willing to work while a guardian is at home? YesNo
Any other comments or job preferences:



Employment History and Education - Begin with your most recent job and include any childcare experience.

1. Employer, address, phone number and contact person.
Start Date:
End Date:
 
Reason For leaving
Duties

2. Employer, address, phone number and contact person.
Start Date:
End Date:
 
Reason For leaving
Duties

2. Employer, address, phone number and contact person.
Start Date:
End Date:
 
Reason For leaving
Duties


Education History

1. Name of School / College:
Dates Attended:
Describe Program of Studies:
Degree / Diploma Attained:

2. Name of School / College:
Dates Attended:
Describe Program of Studies:
Degree / Diploma Attained:

3. Name of School / College:
Dates Attended:
Describe Program of Studies:
Degree / Diploma Attained:
Do You have First Aid Training?
Expiration Date:
Other related training
References:








Questionairre Section - Please fill in with a brief descriptive answer.

1. How would you balance your childcare duties with your household duties?
2. What is your philosophy on behaviour management?
3. What do you believe is a healthy dinner for a child?
4. If a child in your care broke their arm, what action would you take?
5. If two or more children wanted your attention at one time, how would you resolve the situation?
6. Describe some procedures you have followed to insure that the children were not exposed to danger.
7. In one of your past childcare jobs, describe a typical days work.
8. Think of some of the activities you provided for the children and list them below. State what age group would be appropriate for the activity.
 
 
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