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Cardinal Nannies & Caregivers
Application Form

Please fill out the following form completely and a Cardinal Nannies representative will contact you shortly to confirm your information and set up an interview with qualified applicants. Thanks for choosing Cardinal. If you experience issues with the form, please contact us at moyra@cardinalnannies.com

Name *
Address *
City *
Province *
Postal Code *
Phone Number *	### - ### - ####
Cell Phone	### - ### - ####
Email
Are you afraid of pets? *	Yes   No
Are you allergic to 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 *
Spoken Language *
Other Training & Work Experience *
Able to work: *	Monday to Friday    Part-time    Full-time Shifts   Saturday    Part-time   Full-time Shifts    Sunday    Part-time    Full-time Shifts
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? *	yes   no
If children, what age group?	Babies   Toddlers    Preschool    School Age
Where are you able to work? *
Are you between 18 and 64 years of age? *	Yes   No
Do you have a Canadian Social Insurance number? *	Yes   No
Are you on a work permit? *	Yes   No
Are you legally able to work in Canada? *	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? *	Yes   No
Employment History: Employer, Contact, Date, Job Description, Salary - Employer 1 *
Employment History - Employer 2
Employment History - 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? *	Yes   No
If yes, please specify: *
Have you ever worked with the handicapped? *	Yes   No
If yes, would you like to be considered for such a position? *	Yes   No
When can you start? *
How long are you available? *
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