A-Class Nannies & Caregivers Inc

A-CLASS NANNIES & CAREGIVERS INC. Unit 208, 3900 Hastings St. Burnaby, British Columbia V5C 6C1 Telephone/Fax: 604.320.0077 Cell/Text: 604.780.0344/778.891.2720 Website: www.aclassnannies.com Email: [email protected]

NOTE: ALL INFORMATION PROVIDED MUST BE ACCURATE DESCRIPTIONS OF YOU. IT IS VERY IMPORTANT THAT YOU WRITE CLEARLY & IN BLOCK LETTERS. PLEASE SIGN EACH PAGE.

PERSONAL INFORMATION (AS IN YOUR PASSPORT)

Date: Position Applying for: ( ) Live In ( ) Live Out ( ) Part time ( ) Others When did you arrive in Canada? Name: Given Name Last Name Middle Name Gender: Age: Height: Weight: Yea Date of Birth: Month Day r Place of Birth Nationality: Religion: Marital Status: Number of Children (if applicable): Ages:

EDUCATIONAL INFORMATION

College: School: Address: School Year: Course Taken: High School: School: Address: School Year: Additional Training or Seminars Attended

WORKING EXPERIENCES HISTORY

Employer Job Title: Location: Contact Number: Period of Employment: to Childcare Elderly Care Ages: Duties and Responsibilities: (List all duties) Reason for leaving:

Employer: Job Title: Location: Contact Number: Period of Employment: to Childcare Elderly Care Ages: Duties and Responsibilities: (List all duties) Reason for leaving:

I hereby declare that all the information on this form and enclosed documents are true in every respect. Please sign: ______Local Application Form Property of A-Class Nannies and Caregivers Inc. Page 1 of 5 Continuation of employment… Employer: Job Title: Location: Contact Number: Period of Employment: to Childcare Elderly Care Ages: Duties and Responsibilities: (List all duties) Reason for leaving:

(Please provide separate sheet if necessary)

DOMESTIC SKILLS and OTHER QUALIFICATIONS

Do you know how to operate the following appliances: Microwave: Dishwasher: Oven: Iron: Washer: Dryer: Vacuum: Blender: Do you know how to bake? Do you know how to cook? Type of dishes you cook: Rate your cooking: Excellent/Very Good Good Others: Do you have knowledge in CPR or First Aid? When and where did you take the First Aid training?

Summary of Experiences (Including volunteer works, experiences with own family, etc.)

Experience with: Ages Years of Experience and where: Newborn 2 to 5 years old 6 to 10 Over 10 years old Twin or Triplet Total Years of Child Care Experience: What is the maximum number of children you have cared for? Indicate the maximum number of children you can care for: What ages of children are you most comfortable with?

Elderly Care Experience: Yes or No What age(s): Any health conditions: Where you have obtained the experience: Total Years of Experience:

Person with Special Needs Yes or No What age(s): Indicate the condition: Where you have obtained the experience: Total Years of Experience:

Do you have relatives here in Canada? Please give their names and phone numbers below.

I hereby declare that all the information on this form and enclosed documents are true in every respect. Please sign: ______Local Application Form Property of A-Class Nannies and Caregivers Inc. Page 2 of 5 HEALTH CONDITION

Do you have allergies? Do you have back problems? Do you have high blood pressure? Any physical or mental illnesses? Do you drink alcohol? Do you smoke? Have you been hospitalized before? Please provide details Have you had any surgeries in the past? Please provide below: details below:

ABOUT YOU

Hobbies and Interests: Sports you like: Musical instrument you play: Do you know how to swim? Do you have a driver’s license? Which do you drive: Automatic Standard Knowledge in English: Knowledge in French: Read: ______Speak: ______Write: ______Read: ______Speak: ______Write: ______Language at birth: Other Language:

Indicate your strong points or traits:

Indicate your weak points or traits:

PLEASE NOTE: The more you restrict yourself, example the area you want to work in, the nationality you want to work for or the ages, the less chance for you to get hired sooner.

Where do you want to work? Cities List down particular cities you want to work in and why.

Rural Areas (places that are slightly away from the city) Anywhere in Canada

For the position and employer you are looking for right now, which do you prefer?

Childcare Elderly Care Care for person with disabilities Any Please explain why you chose your answer and not the other.

I hereby declare that all the information on this form and enclosed documents are true in every respect. Please sign: ______Local Application Form Property of A-Class Nannies and Caregivers Inc. Page 3 of 5 INTERVIEW QUESTIONNAIRE NOTE: Please do not leave a blank space. Put N/A if the question is not applicable to you. Use a separate sheet of paper if necessary. Your answers and the manner of your answering will reflect your personalities and qualifications for the position you are pursuing. So be sure to read and understand each item before answering. If you do not understand or you need help with any of the questions below, please ask A-Class Nannies & Caregivers Inc. representative.

1. Why should an employer hire you? What makes you the right person for the job?

2. Any religious belief(s) or practice(s) that can be a hindrance to future employment.

3. Are you comfortable to work with any race, nationality or religious belief? If not, please list down those nationalities and explain why.

4. Your hours and days of work or your days off are mainly dependent on the employers schedule and need for your service. What if the employer has a changing shift (like nurses, doctors, stewardess, etc) and they change your days off to Monday and Tuesday, or any day, other than Saturdays and Sundays, what will you do?

5. If there are issues between you and the employer that should be discussed or resolved inside the household, or you have concerns about your work or employer, do you think it is proper to tell or discuss it to your friends or relatives, or let them get involved? What should be the proper way to resolve it?

6. Are you the type of person who complains a lot or the one that finds solution? Give us some examples which you consider unfair and what you think should be done.

7. Are you capable of making reasonable decisions in any given situation? Or do you let someone else decides for you or do you follow someone else’s decision?

8. In finding work, your friends or someone you know told you that you should not work for a certain employer (example employers of different nationalities), should you listen?

9. When friends get together, it is common to compare notes about your employers or job, like what hours they work, what duties they do everyday, etc. Every employment is different from the others. Would you demand your employer to give you the same working conditions like what your friends have? And if the employer can not give you what you like, would you abandon your responsibilities and quit?

10. Is there any aspect of housekeeping duty or care giving aspect that you are unable to perform?

11. What if you find an employment that is far from your relatives or friends, would you still take the job?

12. You found an employer, but your relatives or friends/boyfriend/girlfriend told you they don’t like the job for you, what would you do?

13. What do you think about making or taking personal calls during work?

14. Caregiver is not an easy but rewarding job. How has your job as a caregiver changed the way you view life in I hereby declare that all the information on this form and enclosed documents are true in every respect. Please sign: ______Local Application Form Property of A-Class Nannies and Caregivers Inc. Page 4 of 5 general, changed your attitude, or the way you appreciate things?

A-CLASS NANNIES & CAREGIVERS INC. Unit 208, 3900 Hastings St. Burnaby, British Columbia V5C 6C1 Telephone/Fax: 604.320.0077 Cell/Text: 604.780.0344 Website: www.aclassnannies.com Email: [email protected]

Contact information

Your Name: As it appears in your passport.

Home Phone Number: Work Phone Number: Mobile Number: Alternative Numbers: Email Address:

Residential Address

Mailing Address (if different from the residential Address)

DECLARATION:  I authorize and consent A-CLASS NANNIES and CAREGIVERS INC. to verify the statements provided on this form, the employment reference(s) without any liability arising thereof.  I authorize and consent A-CLASS NANNIES and CAREGIVERS INC. to forward all my documents or personal information to employers.  Employment accepted through A-CLASS NANNIES and CAREGIVERS INC. would be subjected to source deductions from Canada Customs and Revenue Agency, which includes Canada Pension Plan, Employment Insurance and Federal and Provincial Taxes.  I certify that all information(s) and document(s) submitted to A-CLASS NANNIES and CAREGIVERS INC. is true, genuine, and correct to the best of my knowledge.

Full Name Signature

Date Signed

I hereby declare that all the information on this form and enclosed documents are true in every respect. Please sign: ______Local Application Form Property of A-Class Nannies and Caregivers Inc. Page 5 of 5