Telephone
604-985-3654
E-mail
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Employer Description


Name:
Date:
Address:
City:
Telephone Number:
Alternate Contact Number:
Children Information: 1. Name

Personality

Age

Comments

2. Name

Personality

Age

Comments

3. Name

Personality

Age

Comments

4. Name

Personality

Age

Comments
Any Pets? If yes, please describe:
Is the home near any recreational facilities? YesNo
If Yes, please describe:
Is the home on a bus route? YesNo
How many rooms in the home?
Approximate size of home:
Any outdoor area? YesNo
Will the caregiver live in? YesNo
If yes, please select appropriate amenities: Suite Bedroom
Bathroom
Television
Phone
Stereo
Private Entrance
Any other extras?
Approximate size of living area?
Should the caregiver be a driver? YesNo
Should the caregiver be a swimmer? YesNo
Additional qualities?


Employee - Duties and Expectations

Please choose the appropriate responcibility designation ? Childcare
PrimarySecondary
Household
PrimarySecondary

Household Expectations

Meal Prepartion Breakfast
YesNo
Lunch
YesNo
Dinner
YesNo
Sweeping DailyWeeklyBi-Weekly
Washing Floors DailyWeeklyBi-Weekly
Dusting DailyWeeklyBi-Weekly
Bathrooms DailyWeeklyBi-Weekly
Vacuuming DailyWeeklyBi-Weekly
Kitchen DailyWeeklyBi-Weekly
Children Laundry DailyWeeklyBi-Weekly
Parents Laundry DailyWeeklyBi-Weekly
Ironing DailyWeeklyBi-Weekly
Additional?

Childcare Expectations

Please describe all child care expectations:
Start Date:
End Date:
Work Hours (Daily)?
If part time specify days and hours?
Monthly Salary?
Medical? YesNo
Dental? YesNo
Any other benefits?
Any additional comments:


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