Nannies, Caregivers, Housekeepers, House Managers, Overseas live-in Caregivers

Become a Home Helper We are a domestic help employment agency, located in Toronto, Canada. We are looking for experienced and professional domestic helpers including nannies, caregivers, housekeepers and house managers. Do you have what it takes to join the Home Helpers family? Are you experienced, caring and committed, with excellent references? Is there an area of personal care about which you are passionate and excited? If so, Home Helpers may be right for you. Take a moment to fill out the information in the form below, to see how your qualifications fit with our requirements.
Section I: Identification:
Are you:	Female Male
First Name:		Middle Name:
Last Name:
Address:
City:		Province:
Postal Code:
Home Phone:		Work Phone:
Note: you must enter a valid email address to change your information later?
Cell Phone:		Email Address:
What kind of authorization do you have to work?
Select one:		Expiry:


Section II: Personal Information:
Birth Place:
Do you have any family/friends we may contact in case of emergency?
Contact:
Contact's Phone Number:
How well do you speak English?		Good Fair Poor
What other languages do you speak?
Languages:
Have you ever been arrested?	Yes No	If yes, for what?
Do you have a valid driver's license?	Yes No	How long have you been driving?
Do you swim?		Do you like pets?	Yes No
Do you know how to cook?		Describe your Personality Traits:
Are You Self-Directed?	Yes No
Do you belong to any clubs or organizations?		Yes No
Identify:

Section III: Medical Information:
Date of birth:		Age:
Height:		Weight:
Smoke?	Yes No
Have you been hospitalized?	Yes No	For what?
Are you in good health?	Yes No	If no, please explain:
Do you have any allergies?	Yes No	If yes, please comment:

Section IV: Skills and Certificates:

Do you have any childcare training?

Yes No

If yes, please describe:

Do you have first aid training?

Yes No

If yes, please describe:

Please check which of the following areas you have experience in and what you are prepared to do:

	Have Experience	Willing to Do	Length of Experience
Care for newborn
Care for babies 1-12 months of age
Care for toddler 1-3 years of age
Care for school-aged children
General housekeeping including laundry & ironing
Sewing/mending clothes
Formal Serving
Care for a disabled person
Companion for elderly
Care for physically or mentally challenged
Work in a Formal Home
Work in a Single Parent Home

Section V: Work History:
Previous Employer #1 - Information:
Name of Employer:
Address:
Telephone number:		Salary:
Length of Employment:
Duties:
Number of Children & Ages:
Reason for leaving:
Previous Employer #2 - Information:
Name of Employer:
Address:
Telephone number:		Salary:
Length of Employment:
Duties:
Number of Children & Ages:
Reason for leaving:
Is your present employer aware that you are seeking other employment?		Yes No
What salary do you expect?
Type of employment	Live In Live Out
Preferred employment location:	City Suburb Country

Section VI: References:
References, other than present or former employers
Name #1:		Telephone:
Address:
Name #2:		Telephone:
Address:

Section VII: Photograph:
If you wish, you may attach a photograph of yourself:
File:

Section VIII: Agreement:
In consideration of Home Helpers Agency introducing me to their clients with the intention of finding suitable placement for me, I agree to the following: 1. That all information provided to me will be treated with utmost confidentiality. 2. That I will not introduce to a client referred to me by Home Helpers, any domestics for the purpose of employment. 3. That I will not make a recommendation to the client or a friend of the client on behalf of another party, otherwise I will also be liable to Home Helpers Placement Agency. 4. That I will not accept any employment from another client who was recommended to me through the client introduced by Home Helpers Placement Agency. 5. That under no circumstances I will release the client's name, addresses, or telephone number to another party. I have read and agree to the above terms and conditions as set out by Home Helpers Placement Agency in consideration of their agreement to introduce me to their clients for domestic employment.
Today's Date:		in the city of Toronto.

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