1. Recent photograph(s);
2. "Dear Family" letter in your own handwriting;
3. Two letters of references;
4. Copy of school diploma(s).

Position desired: Live-in _____ Live-out _____ Nanny _____ Housekeeper _____ Cook _____

Name: _______________________________________________________________ (Surname, Given names)

Social Insurance Number: ____________________________________________ (If available)

Present Address: _____________________________________________________________________________

Telephone: _____________________________________ Fax: ________________________________________

Email address: ______________________________________________________________________________

Permanent Address: __________________________________________________________________________

Telephone: _____________________________________  Fax: ________________________________________

Email address: ______________________________________________________________________________

Date of Birth: ________________________ Place of Birth: __________________________________________

Nationality: ____________________________________________________

Knowledge of English: Very good _____ Good _____ Fair _____

Other languages: _______________________________________________

Religion: ______________________________________________________

Weight: ___________________ Height: ____________________________

Marital Status: _________________________________________________

Dependents: ___________________________________________________

Education and training:_______________________________________________________________________

Parent's Profession: Mother: ______________________________ Father: ______________________________

DOMESTIC EXPERIENCE:

General Housework: _________________________ Laundry: ___________________________________

Ironing: ___________________________________ Cooking: ____________________________________

Baking: ___________________________________ Waiting at table: ______________________________

Do you have brothers / sisters? _________________ What ages are they: _________________________

Do you have a driver's license? _________________ For how long? _____________________________

Have you taken care of children? _______________ What ages? _______________________________

Do you like pets? ___________________________ Any allergies? _____________________________

Do you smoke? ____________________________ How many daily? ___________________________

Do you swim? _______________________________ Do you like outdoor sports? _________________

Hobbies and Interests: ________________________________________________________________

Would you prefer a household with many or few children? _____________________________________

Ages preferred: _____________________________________________________________________

Do you prefer placement in a city, suburb, small town or rural area? ______________________________

Name, Address and Telephone No. of Present and Previous Employer: Duties: From - To:

1. _________________________________________________________________________________________

Reason for leaving: ___________________________________________________________________________

2. _________________________________________________________________________________________

Reason for leaving: ___________________________________________________________________________

3. _________________________________________________________________________________________

Reason for leaving: ___________________________________________________________________________

4. _________________________________________________________________________________________

Reason for leaving: ___________________________________________________________________________

Do you have relatives/friends living in Canada? Yes: _____ No: _____

If Yes: Relationship: ____________________________ Name: _______________________________________

Address & Tel. No.: __________________________________________________________________________

May we contact any of the above references? _________________________________

How is your general health? ___________________________________________________________________

Do you have a valid passport? ______________________

Are you able and willing to sign a one-year contract? _____________________

When are you available to start work? ___________________________________________________________

Have you applied previously for a work permit for Canada? ________________________________________

If Yes, was work permit refused - and if so, for what reason? ________________________________________

I hereby certify that I have answered the above questions to the best of my knowledge and belief.

Date: ____________________ City: _________________________ Signature:___________________________