RESCUE NANNY
Application Form
First Name
Last Name
Phone Number
E-mail address
Date of birth (month/day/year)
Type of work you are looking for
Full time live in
Full time live out
Part time
Casual
Live In Caregiver
Housekeeping
Sex
female
male
Marital Status
Single
Married
Separated
Common Law
Number of Children
0
1
2
3
4
5
6
Spoken English
Good
Fair
Poor
Written English
Good
Fair
Poor
Current Address
Current Employer
Include name, address and phone number of employer, dates of employment and duties performed. Please mention number and ages of children
Previous Employer
Include name and address of employer, dates of employment and duties performed. Please mention number and ages of children
Check all duties you are willing to do
Light Housekeeping
Full Housekeeping
Laundry
Children Meal Preparation
Family Meal Preparation
Gardening
Pet care
Errands (groceries)
Do you have experience with
Newborn/Babies
Toddlers
Twins
Pre-schoolers
School-aged
Teenagers
Special Needs
Pet Care
Resume
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Letter of Reference
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Work Permit
If required
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Police Background Check
If required
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Drivers License
Yes
No
Can you swim?
Yes
No
Hours Available Daytime
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Hours Available Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Are you willing to work overtime?
Yes
No
Sometimes
Educational Background
Please check all that apply
High school
Undergraduate Degree
Graduate Degree
Vocational Certificate
Caregiver Certification
First Aid Course
CPR Training
Type of Degrees or Certificate
Any other applicable courses or training
Character Reference 1:
Full Name
Telephone Number
Relationship
Character Reference 2:
Full Name
Telephone Number
Relationship
Character Reference 3:
Full Name
Telephone Number
Relationship
SUBMIT FORM
