E-Form

Cardinal Nannies & Companions Inc.
Employment Application

Name		Telephone
Address		Cell Phone
Address 2		E-Mail
City		Province
Country		Alternate Contact
Postal Code		Smoker?	Yes No
Are you allergic to pets?	Yes No	Are you afraid of pets?	Yes No
Do you have a valid drivers license?	Yes No	Do you have use of a car?	Yes No
Do you have any physical problems which would preclude you from satisfactorily performing the duties involved in this position?	Yes No
Have you taken a First Aid or CPR course? When?
Education History
Languages Spoken
Other Training & work experience
Interests & Hobbies
Sports
What do you find are your strong and weak points
Able to Work	Monday to Friday Part-time Full-time Shifts Saturday Part-time Full-time Shifts Sunday Part-time Full-time Shifts
yes no:	Are you willing to do cooking?
yes no:	Are you willing to do laundry?
yes no:	Are you willing to do housekeeping?
yes no:	Are you experienced in childcare?
yes no:	Are you experienced in the care of the elderly?
Would you prefer to work with Children or the Elderly
If children what age group	Babies Toddlers Preschool School Age
Where are you able to work
yes no	Do you have a Canadian Social Insurance Number?
yes no	Are you between 18 and 64 years of age?
yes no	Are you legally able to work in Canada?
yes no	Are you on a work permit?
yes no	Are you bondable?
yes no	Have you been bonded previously?
yes no	Do you give permission for a criminal record check for bonding purposes?
Employment History: Employer, Contact, Date, Job Description, Salary
Employer 1
Employer 2
Employer 3
Would you consider a short term live-in or a long term live-in as a Nanny, or as a Companion to an elderly person?
If yes please specify.
yes no	Have you ever worked with the handicapped?
yes no	If yes would you like to be considered for such a position?
When can you start?
How long are you available?

	Cardinal People Care
	Cardinal Nannies & Companions Inc. 519 Dundas Street East Suite 3 Whitby, Ontario, Canada L1N 2J5 www.cardinalnannies.com	Phone: (905) 666-2228 Toll Free 1-800-219-8059 Fax: (905) 666-9689 E-mail: moyra@cardinalnannies.com