APPLICANT ONLINE APPLICATION FORM
Current Country
 Last Name
 Middle Name
 First Name
Gender
 Age
 Marital Status
 Nationality
Date of Birth
 Place of Birth
 Height
 Weight
Religion
 Number of own children
 Children's ages
Language Spoken
 English
 French
 Other
EDUCATION:
What is the highest level of education you achieved?(School name, address & school year attended)
University
 Degree
College
 Diploma
Other
WORKING EXPERIENCE HISTORY: (Present to Previous)
1. Employer Name
 Telephone:
Address
 Date of Employment:
 To
Ages of Children
 Ages of Elderly
Duties
Reason for leaving
May we contact this employer for reference checks?
 Yes
 No
If No, Why?
2. Employer Name
 Telephone:
Address
 Date of Employment:
 To
Ages of children
 Ages of Elderly
Duties
Reason for leaving
May we contact this employer for reference checks?
 Yes
 No
If No, Why?
3. Employer Name
 Telephone
Address
 Date of Employment:
 To
Ages of Children
 Ages of Elderly
Duties
Reason for leaving
May we contact this employer for reference checks?
 Yes
 No
If No, Why?
Other Professional Experience: (Company / Position / Date of Employment)
QUESTIONNAIRE
1. Number of years total working as a nanny
2. Number of years total working to take care of the elderly
3. Number of years total working to take care of disabled or handicapped
4. As a Nanny/Caregiver, what duties are you comfortable performing (please check all that apply)
Caring for infants (0 to 24 months)
 Caring for children (2 to 12 years old)
 Caring for teenagers
Caring for handicapped /special needs
 Caring for elderly
5. Maximum number of children you can care for at once?
6. Maximum number of elderly / handicapped you can care for at once?
7. Can you work for a single parent?
 Yes
 No
8. Can you travel with your employer's family if needed?
9. Can you take care of children / elderly / handicapped while your employer is away for short duration?
10. Can you assist the children with their homework (school studies)?
 Yes
 No
11. What school subjects were you very good at?
 Math
 English
 Writing
 Reading
12. Are you willing to do (please check all that apply)
 housework - dusting, vacuuming, etc
 pet care
meal preparation / cooking
 laundry
 ironing
 gardening
13. Do you swim?
 Yes
 No
 If yes, what level (beginner, average, excellent)
14. Do you have Standard First Aid and / or CPR training?
 Yes
 No
If yes, date and course achieved
15. Can you work flexible hours / days?
 Yes
 No
16. Do you smoke?
 Yes
 No
17. Do you drink alcohol?
 Yes
 No
 Occasionally
18. Do you have a driver's licence?
 Yes
 No
19. What are your interests/hobbies?
20. When does your current employment contract finish?
21. If an employer hires you, can you start immediately?
 Yes
 No
22. If not, how much time do you need?
23. Do you have relatives living in Canada?
 Yes
 No
 If yes, please state name, address & phone no.
24. Do you have friends living in Canada?
 Yes
 No
 If yes, please state name, address & phone no.
25. Where did you hear about THH CANADA INC. (formerly The Healthy Home) Caregiver Services?
26. Do you consider being a nanny / caregiver a job
 or a career choice
27. Please state any additional information that you feel can help you find an employer. What sets you apart from other candidates? Why
should you be hired over other candidates?
PERSONAL CONTACT INFORMATION:
Email Address
Telephone number/Cell number
Confirm email address:
Alternate Phone number (Friend or relative)
Best Days & Times to Contact:
Present Mailing Address:
Do you agree to have your photo & info online in our website?
 Yes
 No
Please click the "submit" button once. We request you mail (through post office) to us your pictures along with all the requirements
required. Once we receive all the documents we will contact you for further verification.
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THH CANADA INC.