Nanny / Caregiver Interview Form

To be completed by the applicant in foreign language.

I would like to work as (you can circle more options):

• चिल्द्मिंदर

• Nanny live-in
• Nanny live-out
• Caregiver live-in
• Caregiver live-out


1. Name

2. Phone

3. Address

4. Citizenship status:

5. Age: Birthday:

6. First language:

7.English abilities?

Other languages?

8. Do you have children of your own? ____How old? ___________________________
9. What other babysitting/childcare/nanny/eldercare/disabled experience do you have?



10. Do you still sit for prior clients? _________ Why or why not? _________________
12. What are the ages of other children/seniors/disabled you have watched?
______________________________________________________________________

______________________________________________________________________
13. What do you like about caring for children/seniors/disabled?
______________________________________________________________________

______________________________________________________________________

15. Do you object to (shopping, cleaning, errands) while watching the child(ren)?
______________________________________________________________________
16. Do you cook? If so, what? Are you familiar with the food in Vancouver? ________
17. What do you do in your spare time? Hobbies? ______________________________
20. What kind of activities do you enjoy doing with children? ____________________
How about in the rain? ___________________________________________________
21. Do you know CPR and other emergency procedures, such as infant choking?
______________________________________________________________________
24. How much do you charge? Minimum ____________ Maximum _____________
(Minimum wage is $8, while the average fees per hour for live-out is $12 to $15)
25. Do you have any references? We need at least two written and two verbal.
26. Do you have any questions? ____________________________________________
______________________________________________________________________

Live-out Caregivers Only
1. Do you hold any other jobs other than taking care of children? _____________

2. How will you get to work each day? (if live-out only) ____________________


3. What days and times are you available? _______________________________
4. Would you be comfortable getting acclimated to our family by meeting the children at least once before you start caring for them? ___________________________________

5. Are you flexible with your hours or are there some hours you are not available? ______

______________________________________________________________________
Other:

Have you ever had to perform first aid (ie. CPR, artificial respiration, electric shock, choking etc) on anyone?

What is the emergency number for ambulance, fire, and police in Vancouver?

What is the closest you have come to an emergency situation you have ever encountered while caring for children/seniors/disabled?

What is your educational background?

Why do you want to be a nanny/caregiver?

How long have you been a nanny/caregiver?

What are your long-term career goals?

Describe a nightmare nannying situation for you.

Describe a gratifying nannying situation for you.

Do you have any special dietary/religious requirements or have any health issues?

Do you want to take a class while you are in Vancouver? (ESL)

Do you plan to move to Vancouver through the live-in caregiver program? ______________

What kind of a commitment are you willing to make: 6-months? 12-months 24-months _____

Describe how you might handle conflict/issues with your “family”, especially if there are differences in philosophy of raising children or in the home atmosphere?

How comfortable are you with technology? (Internet, blackberry etc.)

Is there anything else that is important to you in a family?

Live-in Caregivers Only:
Do you have at least 12 months of experience in paid employment as child caregiver, obtained in last 3 years, excluding work for relatives? _______

How many children are you willing to take care of? ______________

CHILDREN’S ACTIVITIES & DOMESTICE DUTIES (circle below your experience & capabilities)
Art & Coloring Walks or Hikes Story Telling Crafts
Swimming Class Tutoring Bike Riding Puzzles Games
Drop off & Pick-up from School Vacuuming & Dusting Laundry
Cooking Ironing Baking House Cleaning Grocery Shopping

ELDERLY CARE/ WITH SPECIAL NEEDS PERSON (give details below on you experience & capabilities)
Do you have paid experience looking after the elderly/handicapped? ______
If yes, how many years _____________
Have you worked as a caregiver for elderly/with special needs person within the last 3 years? __________
Describe your experience (age and condition of the person, your duties, responsibilities, etc.) ¬¬¬¬________________________________________________________________¬¬¬¬¬______________
______________________________________________________________________________
______________________________________________________________________________

Please explain, why will you make a good caregiver: ___________________________________
______________________________________________________________________________
______________________________________________________________________________
___________________________________________________________________________________________________________________________________________________________

How did you hear of this Agency? _________________________________________________
_____________________________________________________________________________

AGREEMENT AND AUTHORIZATION

I _________________________________, hereby authorize European InHome Services to conduct a thorough background check, which may include information of my character, education, past work experience, driving record and a police check. I acknowledge that all the information provided by me on the above application form is true to the best of my ability.
I understand that European InHome Services is acting solely as a referral agency, and at no time will be my employer. I am under no obligation to accept a job from anyone that European InHome Services refers to me.
I understand that any live-in caregiver position I accept through European InHome Services will involve the deduction of income tax, unemployment insurance benefits and Canada Pension and that I become the employee of the family that hires me and not European InHome Services.
I agree to keep all the information about my employers confidential and respect the family’s privacy.
I solemnly swear and understand all of the foregoing statements in this contract and I confirm with my signature below.


__________________________________________ Date: _______________________

KONTAKT International, Recruitment Agency
Poland, Rzeszów, Bernardynska 11; www.kontakt-international.pl