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Nanny Application
Please attach your resume at the bottom of this form: (Click to acknowledge)
Contact Information
First Name:
Middle Name:
Last Name:
Gender:
Male
Female
Date of birth:
Email:
How did you hear about our agency / web site:
Address 1:
Address 2:
City:
Province:
Not Specified
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Not Selected
Country:
..select country..
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia And Herzegovinia
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, DR Of The
Cook Islands
Costa Rica
Cote D'ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
France, Metropolitan
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard And Mcdonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, DPR Of
Korea, Republic Of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, FYR Of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, FS Of
Moldova, Republic Of
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Kitts And Nevis
Saint Lucia
Samoa
San Marino
Sao Tome And Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia (Slovak Republic)
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
Spain
Sri Lanka
St Vincent And The Grenadines
St. Helena
St. Pierre And Miquelon
Sudan
Suriname
Svalbard And Jan Mayen Islands
Swaziland
Sweden
Switzerland
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Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Viet Nam
Virgin Islands - British
Virgin Islands - U.S.
Wallis And Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Nationality:
Postal/Zip Code:
Day Number:
Evening Number:
Profile Image
Main Photo:
Photo 2:
Photo 3:
Why a family should choose you as their nanny?
Please give a description of why a family should choose you. This is given to potential families and is available on the website when a family searches for you.
What job are you looking for?
Live-in or Live-out:
Live-in
Live-out
Full-time or part-time:
Full-time
Part-time
Nanny:
Caregiver for the Elderly:
Caregiver for the Disabled:
What province would you like to work in?
Specify Province:
Does not Matter
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Not Selected
Please area (Town) would you like to live in?
1st Choice:
2nd Choice:
3rd Choice:
Preferred start date:
or ASAP
Weekly salary desired:
Can you make a one year commitment?
Yes
No
Are you legally able to work in Canada?
Yes
No
What is your status in Canada?
Canadian Citizen
Landed Immigrant
Live-in caregiver program
Other
If Other: (please specify)
Education
High School Date graduated:
College / University:
City / Country:
Years attended:
Date graduated:
Degree:
Education Type:
Educational / Teaching
Business / Commerce
Computer Science
Engineering
Midwifery
Nursing / Medical
Physical Therapy
Secretarial
Other
Special courses attended:
Height:
Weight:
What languages do you speak?
Do you have a driving license?
Yes
No
Can you drive automatic:
Can you drive standard:
Do you own a car that you would want to bring with you?
Yes
No
Have you had any traffic tickets or auto accidents?
Yes
No
Please explain:
Do you swim?:
No
Comfortable in water
Can swim but not confident
Confident swimmer
Very confident swimmer in deep waters
Are you certified in CPR?
Yes
No
Date:
First aid?
Yes
No
Date:
Do you smoke?
Yes
No
Do you have a criminal record?
Yes
No
If yes, please explain:
How would you rate your overall health?
Excellent
Good
Fair
Poor
Do you have any physical disability which would prevent you from performing specific kinds of work?
Yes
No
If yes, please explain the work limitations:
What is your energy level?
Excellent
Good
Fair
Poor
Are you now, or have you been treated for:
A drug or alcohol problem?
Yes
No
An eating disorder?
Yes
No
Do you have allergies?
Yes
No
If yes, please explain:
Do you like pets?
Yes
No
Are you willing to take care of pets?
Yes
No
If no, please explain:
Do you have any physical or health limitations?
Please explain: I.E. Poor back (not able to lify more than 20 pounds such as an infant?)
Childcare / Elderly Care Experience:
Years of experience:
No Experience
1 - 2
3 - 4
5+
What age child do you prefer working with?
0 - 8 Months
9 - 18 Months
18 Months - 2 Years
2 Years - 4 Years
4 Years - 6 Years
6 Years - 10 Years
10 Years - 12 Years
12 years or more
Elderly / Disabled Care
Least enjoy?
If happy, how long would you consider staying with a family?
Are you willing to travel with the family?
Is there any other information you would like to add that would be helpful in placing you with the right family?
What are your hobbies, interests?
What do you see as your personality strengths?
What do you see as your personality weaknesses?
Describe your personality?
Personal Description (viewable by site visitors)(minimum of 500 characters):
Do you have experience with any type of special needs?
Please explain:
Preferred schedule:
What is your desired schedule?
References:
Name:
Home Phone:
Work Phone:
Relationship
On a scale of 1 to 10 (10 being highest), please rate the following as honestly as possible.
Abiltiy to be a self starter:
1
2
3
4
5
6
7
8
9
10
Sense of humor:
1
2
3
4
5
6
7
8
9
10
Patience:
1
2
3
4
5
6
7
8
9
10
Common sense:
1
2
3
4
5
6
7
8
9
10
Control of temper:
1
2
3
4
5
6
7
8
9
10
Ability to follow directions:
1
2
3
4
5
6
7
8
9
10
Ability to take initiative:
1
2
3
4
5
6
7
8
9
10
Neatness:
1
2
3
4
5
6
7
8
9
10
Maturity:
1
2
3
4
5
6
7
8
9
10
Sense of caring:
1
2
3
4
5
6
7
8
9
10
Cooking skills:
1
2
3
4
5
6
7
8
9
10
General household duties:
1
2
3
4
5
6
7
8
9
10
Ironing:
1
2
3
4
5
6
7
8
9
10
In the space below, write an essay that tells us about you, your family, and where you grew up. Also, tell us about your experiences with children. Please be as specific as possible.
Resume
Please attach your resume below or send your resume via email or by fax: