If you are in need of a caregiver, please complete the employer form below.
Name
Home Phone
Street Address
Work Phone
Apt or Unit #
Cell Phone
City
Fax Number
Province
E-mail
Postal Code
I hereby make application for provision of the following (please check preferences)
Nanny/Childcare
Live-In
Permanent
Temporary
Personal Care Worker
Housekeeper
Live-Out
On-Call Service
Elder Care
Physically Challenged
Location Of Service
Starting Date
Ending Date
Please List names and ages of care recipients:
Type of Caregiver Preferred (Smoker Ok? Pet lover? Etc...)
Job Description
(Duties, Days, Hourly Rate, Hours Per Week, Etc.)
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