Caregiver Canada - Caregiver/Nanny Application

Canadian Caregivers’ Association (CCA) is a non-for-profit organization that was established to protect the rights of Canadian families and caregivers from all over Canada and warn them about malpractices in this business.

The CCA is proud member of Ontario Coalition for Better Childcare.

I AM A NANNY/CAREGIVER
PERSONAL INFORMATION * Indicates required field

First Name*:

Last Name*:

Email Address*:

Nationality*:

Current Place of Residence*:

City, Country*:

Telephone
with Area Code*:

Date of Birth*:

Sex*:

Male Female

Marital Status*:

How many children do you have*:

Date available
to start*:

Your current
mailing address*:

Do you have a valid driver's license*:

Any medical concerns or allergies*:
If "Yes" please explain:

Yes No

Attach picture of yourself*:

Do you have hobbies*

In one paragraph please tell us why you are a good caregiver and should be hired*:

ABILITY IN ENGLISH*

Read	Excellent	Well	With Difficulty	Not at All
Write	Excellent	Well	With Difficulty	Not at All
Speak	Excellent	Well	With Difficulty	Not at All

ABILITY IN FRENCH*

Read	Excellent	Well	With Difficulty	Not at All
Write	Excellent	Well	With Difficulty	Not at All
Speak	Excellent	Well	With Difficulty	Not at All

What other languages do you speak:

EDUCATIONAL PROFILE

What is the highest level of education you achieved?*

University

College

High School

Other

Major:

Date of Graduation*:

Name of University / School*

Do you have CPR Training*:

month year

Date completed:

Do you have any other health/medical/nursing
related training*:
If Yes, please describe:

Yes No

EMPLOYMENT HISTORY

Please describe ONLY work related with children or as a caregiver. Start with the most recent employer.

1. Employer Name and Address:
Position:

Date of Employment:
(From-To)

Employment Duties:

(please provide details)

2. Employer Name and Address:
Position:

Date of Employment: (From-To)

Employment Duties:

(please provide details)

Do you prefer to care only for*:

Children Elder Both

Can you do the following as part of your everyday responsibilities*:

Cooking General House Cleaning
Shopping Driving

PLEASE INFORM US HOW YOU WERE INTRODUCED TO THE CCA:

Search Engine (please specify name & keywords used for the search)

Newspaper Magazine (please specify)

Newsgroup (please specify)

General Recommendation

Additional Comments if any:

MEMBERSHIP

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