All fields marked with * are mandatory.
PERSONAL INFORMATION
* First Name :		Middle Name :
* Last Name :		Height :
Weight :		Date of Birth :
Home Phone :		Cell Phone :
Current Address :		City :
Province :		Postal Code :
Country :		Email Address :
What type of Employment are you looking for?	Childcare Senior Disabled Care	What type of employment would you consider?	Full-time (live-in): Yes No Full-time (live-out): Yes No Part-time (live-in): Yes No Part-time (live-out): Yes No
Country of Birth :		Nationality :
Religion :		Marital Status :
Number Of children :		Age :
Level of English :	Basic  International Advance
Level of Swimming	Good   Very Good	Do you have a valid driver's license?	Yes No
Are you willing to learn to drive?	Yes No
What do you enjoy doing during your free time? Hobbies/Interest
Are you willing to travel with the family on vacations?	Yes No	Are you willing to work evenings/weekends when necessary?	Yes No
Have you ever been convicted of a criminal offence?	Yes No	What is the earliest date you will be available to start working in Canada?
Are you under contract?	Yes No	If yes, when does it expire?
EDUCATION
Have you completed your High School Diploma	Yes No	Guyanese Candidates must list your subjects and Grade Level on CXC Slip
Which level of education have you completed?	University College	Number of years attended
Subject of study		Diploma Achieved
Additional education or training		Have you completed a six-month caregiver course?	Yes No
Do you have CPR training?	Yes No	Do you have First Aid Training?	Yes No
WORK EXPERINCE
Current Employer's Name :		Location of employment :
Start date :		End date :
Are you taking care of children :	Yes No	Are you taking care of elderly :	Yes No
Number of children :		Ages of children :
Childcare Responsibilities		Eldercare Responsibilities
Previous Employer's Name :		Location of employment :
Start date :		End date :
Did you taking care of children :	Yes No	Did you taking care of elderly :	Yes No
Number of children :		Ages of children :
Childcare Responsibilities		Eldercare Responsibilities
What type of experience you have?	Childcare Eldercare
HOUSEKEEPING RESPONSIBILITIES
Housekeeping
Answer the following question in as much details as possible
Why would you make a good caregiver?
Pictures / Photo :	(Only Pictures - JPEG,JPG,GIF)
Attachment 1 :
Attachment 2 :
Attachment 3 :
Attachment 4 :
Attachment 5 :