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 Nannies and Companions Inc. 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

© 2000, Cardinal Nannies and Companions Inc. All rights reserved.