If you are interested in working for a family in Canada, or would like more information, please complete this Caregiver Application Form.

The better we understand your experience and preferences, the quicker and easier we can find a family who will be a great fit. We will review your information and contact you by email or phone, usually in 1-2 business days.

POSITION DESIRED
What position(s) are you interested in?
Caring for children
Caring for the elderly
Caring for persons with disabilities
Housekeeping
Preparing meals
Would you prefer to live with the family in their home?
Yes ("live-in")      No ("live-out")
YOUR CONTACT INFORMATION
Family name:
Given name(s):
Street address:
City:
Province or state:
Postal code:
Country:
Phone (include country code and city/area code):
Mobile phone (include country code and city/area code):
Fax (if available):
Email:
ABOUT YOU
Date of birth:
Place of birth (city, country):
Country of citizenship:
Canadian Social Insurance Number (if available):
Knowledge of English
Very good  Good  Fair
Other languages spoken:
Religion:
Height:
cm
Weight:
kg
How is your general health?
Marital status:
Number of dependents:
Highest education/training (level/degree, discipline):
Mother's occupation:
Father's occupation:
YOUR WORKING EXPERIENCE
What housework have you done in the past?
Doing laundry
Ironing
Cooking
Baking
Waiting at table
If you have brothers or sisters, what ages are they?
Do you have a driver's licence?
Yes     No
If yes, for how long?
years
Have you taken care of children / the elderly / persons with disabilities?
Yes     No
What ages?
Do you like pets?
Yes     No
Do you have any allergies?
Do you smoke?
Yes     No
If yes, how many cigarettes a day?
Do you swim?
Yes     No
What outdoor sports, if any, do you like?
What are your hobbies and interests?
Do you prefer a household with few or many children?
Few (1-3)      Many (4 or more)
Ages preferred:
Where would you prefer to work?
City  Suburb  Small town  Rural area
Do you have relatives or friends living in Canada?
Yes (provide details below)     No
Name:
Relationship:
City, province:
 Phone:
May we call?
Yes  No
Yes  No
Yes  No
YOUR PRESENT AND PREVIOUS EMPLOYERS
Present employer's name:
 City, country:
 Phone:
May we call?
Yes  No
Duties: From: To: Reason for leaving:
Previous employer's name:
 City, country:
 Phone:
May we call?
Yes  No
Duties: From: To: Reason for leaving:
Previous employer's name:
 City, country:
 Phone:
May we call?
Yes  No
Duties: From: To: Reason for leaving:
OTHER IMPORTANT DETAILS
Do you have a valid passport?
Yes     No
Are you able and willing to sign a one-year contract?
Yes     No
When are you available to start work?
Have you applied previously for a work permit for Canada?
Yes     No
Was your application for a work permit ever refused?
Yes     No
If yes, for what reason?
Please feel free to elaborate on any of the above if you wish, or describe any other relevant experience you have.
Finally, how did you hear about us or who referred you to this website?
By entering my name below and submitting this Caregiver Application Form, I confirm that the information I have provided herein is correct and complete to the best of my knowledge, and I consent to the use of this information by A.A. Clara's Agency and its agents for the purpose of verifying the information and providing or facilitating the services I am requesting.
Electronic signature (enter your full name):
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