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           Direct Hire Employment Application

                      Au Pair Nanny Caregiver Agency Inc.

                                     P.O. Box # 76128  Millrise R.P.O.

                                             Calgary,  Alberta

                                            Canada  T2Y 2Z9

                                                    

                                                                                                                                 photo

 

  Name    _____________________   _______________________   _________________________

 

 Present Address                                                           Mailing Address (if different)

______________________________________      ______________________________________

 

______________________________________      ______________________________________ 

 

______________________________________      ______________________________________ 

 

  Phone Number(s) _____________________________     ________________________________

 

  Philippines Phone Number ________________________Fax Number _______________________

 

  E-mail address _______________________________Passport  Number_____________________ 

                                                                                    

 Date of Birth __________________________ Place of Birth ______________________________ 

 

  Country of Residence ________________________   Citizenship ___________________________

 

  Age ______  Height ______  Weight ______  Years of Caregiver Experience __________________

                                                                       

  Marital Status:           Single  □               Married □                  Divorced □                Widowed  □

 

  Spouse’s Name ____________________ If you have children state their ages _____ _____ _____

 

  Languages or Dialects you can speak or write __________________________________________  

                                                                   

High School _____________________________________________   _____________________

                                  name                                                                                years attended

 

College/University________________________________________   ______________________

                                                    name                                                                                years attended

 

Degree/Specialisation _____________________________________________________________    

 

Other courses or training __________________________________________________________

  

Please check all the applicable boxes:

 

Live-In □                  Child Care □                  Disabled Care □                  Elderly Care □

 

Can you drive?              Yes □       No □        Do you smoke or drink alcohol?      Yes □    No □

 

Can you swim?             Yes □      No □         Do you have childcare experience?   Yes □    No □

 

Can you cook?             Yes □      No □        Do you have First Aid Training?        Yes □    No □

 

Will you do pet care?    Yes □      No □         Will you do housework?                 Yes □     No □

 

 Do you have allergies?  Yes □      No □    If yes, please explain ____________________________

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