Become A Nanny Positions Childcare Nanny Eldercare Nanny Special Needs Nanny Become a Live-in Nanny Become a Live-out Nanny Job Application Form Full Name* First Name * Last Name * Email * Phone Number * Current Address * Age * Date of Birth * Place of Birth * Marital Status SingleMarriedDivorcedWidowed Position Applying For * Childcare NannyEldercare NannySpecial Needs NannyBecome a Live-in NannyBecome a Live-out Nanny Do you have any family at your desired location of employment? YesNo LCP (Live-in Nanny Program, if applicable) Arrival Date Work Permit Expiry Months Employed on Live-In Program (according to ROE) Education High School (Year Completed) Post Secondary (Institution Name, Year Completed, Degree Obtained) Childcare/Eldercare Training Courses First Aid/CPR Certification Dates Additional Education Employee Information Preferred Location of Employment EdmontonSt. AlbertSherwood ParkRuralCalgaryOther Date Available to Start How long are you willing to work for your future employer? What is your desired hourly wage? Please describe your current daily routine Are you willing to work flex hours/days? YesNoOccasionally Are you willing to work a split shift? YesNoOccasionally Are you willing to babysit on weekends? YesNoOccasionally Will you work in a single parent household? YesNo Will you work with a stay-at-home mom? YesNo Will you work with a parent that works from home? YesNo Will you work with a child with special needs? YesNo Are you capable of taking full charge of household and childcare duties while your future employer is away on business or vacation? YesNo Do you like pets? YesNo Have you experience caring for any pets? YesNo If yes, what kind of pet(s)? What did you do with this/these pet(s)? Please describe Do you have allergies? YesNo If yes, what are you allergic to? Are you medically and physically fit to work? YesNo If no, are there tasks you are unable to do? Do you have a driver’s license? YesNo If no, are you willing to learn to drive and take driver’s training courses? YesNo If yes, what kind of license? (i.e. international, Alberta) If yes, how many months or years of driving experience do you have? If yes, have you ever been in an accident? YesNo Infant Care Experience Have you cared for babies under 1 year old? YesNo Are you comfortable caring for a newborn? YesNo Are you familiar with the normal stages of milestones/development, for example, ages when infants should: ReachSitCrawlClimbCut Teeth Do you have experience with any of the following: Changing DiapersBottle FeedingMaking/Preparing Baby FoodRoutine Nap/Feeding TimesPreparing for Outings with Baby If you selected “Preparing for outings with a baby” please provide an example Toddler Care Experience Have you cared for children aged 1-3 years old? YesNo Describe what learning activities you would do with a toddler (1-3) Are you willing to read books on child development and childcare? YesNo Are you familiar with safety issues affecting children of this age group such as: Climbing HazardsChoking HazardsDangers of Rough Play Are you familiar with the normal stages of toddler development, for example: Potty TrainingWalkingSpeakingProper NutritionSleep Patterns/Required Amount of SleepGross MotorFine Motor Are you capable of providing a child with age-appropriate discipline? YesNo Please describe how you would handle behavioral issues? Are you willing to escort your future employer’s children to school and extra-curricular activities by foot/bus or car? YesNo Preschool Care Experience Have you cared for children aged 3-5 years old? YesNo Describe what learning activities you would do with a preschooler (3-5) Are you familiar with the normal stages of development of preschool-aged children? Proper NutritionSleep Pattern/Required Amount of SleepGross Motor SkillsFine Motor SkillsAppropriate Play Are you familiar with safety issues affecting children of this age group? Climbing HazardsChoking HazardsDangers of Rough Play Describe how you would teach a child about safety School Age Child Care Experience Have you cared for children aged 5-10 years old? YesNo Have you cared for children aged 10+ years old? YesNo What age group would you prefer to work with? Would you be able to help children with their homework and prepare for tests? YesNo Are you familiar with safety issues affecting children of this age group? Pedestrian SafetySafety on OutingsSafety in Sport/Play Are you familiar with the normal stages of development of school-aged children? Proper NutritionSleep PatternsSelf-EsteemBehavioral/Mental Health Issues What activities would you do with school-aged children? Do you have any special skills or talents? For example, do you play an instrument, love to bake, etc.? How would you share these with the children in your care? Are you willing to take the children to extra-curricular activities and play dates? YesNo References Please list two previous employers that we may contact for a reference check Employer #1 Full Name Employer #1 Phone Employer #1 Email Employer #1 Address Employer #1 Dates Employed From Employer #1 Dates Employed To Employer #2 Full Name Employer #2 Phone Employer #2 Email Employer #2 Address Employer #2 Dates Employed From Employer #2 Dates Employed To Additional Information Are you open to training from a senior nanny? YesNo What is your best cooking dish? Would you be willing to share the recipe with the family you are placed with? Are you willing to take child development courses that may be recommended by your employer? YesNo Are you willing to take a pet training course if required? YesNo Where did you hear about us? FacebookIndeedReferralWebsiteOther If “other”, please specify 1+1=?
