Nanny Application Form Login Information: By entering a username and password, you can save your application and continue the process at a later time. In the future, you'll also be able to log in to our client area. * Username * Password Basic Details: * First Name * Last Name * Address Apt/Suite * City Province --Select-- Ontario Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador North West Territories Nova Scotia Nunavut Prince Edward Island Québec Saskatchewan Yukon * Postal Code * Email * Date of Birth DD  MM  YYYY  * Home Phone ()- Work Phone ()- In case of emergency, please contact: * Name * Phone ()- Educational Experience: Please list relevant educational experiences in reverse chronological order. Institution Name Qualifications Institution Name Qualifications Institution Name Qualifications Employment Experience: Please list relevant employment experiences in reverse chronological order. Employer Name Position Address Apt/Suite Employer Phone ()- Live  In   Out Duties: Start Date End Date Reason for Leaving: Employer Name Position Address Apt/Suite Employer Phone ()- Live  In   Out Duties: Start Date End Date Reason for Leaving: Employer Name Position Address Apt/Suite Employer Phone ()- Live  In   Out Duties: Start Date End Date Reason for Leaving: Do you have any newborn experience?  Yes   No Do you have any special needs experience?  Yes   No If yes, please provide details: Any other related experience? Please provide details: My Employment Preferences: What locations would you consider working in? e.g. Rosedale First Choice Second Available On I prefer to  Live In   Live Out Expected Pay $  Net/Week Last Salary $  Net/Week Overtime Rate $  Per Hour Preferred age of children to care for: Infants Toddlers Preschoolers School Age I am willing to do: Child's Laundry  Yes   No Child's Bedding  Yes   No Family Laundry  Yes   No Family Bedding  Yes   No Child's Ironing  Yes   No Family Ironing  Yes   No Child's Cooking  Yes   No Family Cooking  Yes   No Child's Room  Yes   No Vacuuming  Yes   No Dusting  Yes   No Cleaning Bathrooms  Yes   No Sweeping Kitchen  Yes   No Washing Kitchen  Yes   No Other household tasks? Please provide details: Would you consider Nanny Sharing?  Yes   No Do you prefer parents to work out of the home?  Yes   No Would you consider working for a single parent?  Yes   No Additional Information: Do you have current First Aid/CPR certificates?  Yes   No Are you willing to take a First Aid/CPR course?  Yes   No Are you a competent swimmer?  Yes   No Please indicate any specific certificates or swimming experience: Are you a smoker, social or otherwise?  Yes   No Are you comfortable with pets?  Yes   No If not, please provide additional details: Do you have children of your own?  Yes   No If yes, please provide additional details/ages: Do you have any allergies?  Yes   No If yes, please provide additional details: What are your hobbies and interests? What qualities do you offer a family looking for a nanny? Communication/Languages: English  Speak   Write French  Speak   Write German  Speak   Write Spanish  Speak   Write Driving/Vehicles: Do you have a full Canadian Driver's License?  Yes   No If yes, what date was it obtained? Have you ever had your license suspended?  Yes   No If yes, please provide details: Are you an experienced driver?  Yes   No Can you drive a standard transmission/shift?  Yes   No Legal Information: Do you have a criminal record?  Yes   No Are you willing to have a police check?  Yes   No  I hereby certify that the information provided on this application form is true.

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