Caregiver Application Form

Personal Information
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Educational Background  New Educational Background

Certifications

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Employment History  New Employment History

Please provide your latest employer information below.

Skills/ Preferences

Availability
Cooking Skills
Experience
General
Language
Pets
Transportation
Vehicle Type

References   New Reference

Miscellaneous Questions

Q.) Have you ever submitted an application here before?
Q.) Have you ever been employed here before?
Q.) How did you hear about our CDN ElderCare
Q.) Have you have been given a copy of the job description for the position for which you have applied to review.
Q.) Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accommodation?
Q.) Describe any training or life skills you have that apply to caring/services for a senior:
Q.) Describe any work history you have that would apply to caring for a senior:
Q.) What do you like (or think you would like) most about working with older adults?
Q.) What do you like (or think you would like) least about working with older adults?
Q.) What personal rewards do you get from working with seniors?
Q.) What is your highest education?
Q.) As a condition of employment all employees must be “Bondable” & “Insurable” are you ok getting a criminal & vulnerable sector check done for employment with CDN ElderCare ?
Q.) Are you at least 19 years of age?
Q.) List provinces and counties of residence for the past seven years:
Q.) Have you had any moving traffic violations?
Q.) Have you been charged/convicted of a felony and/or misdemeanor/or served time Yes / No If yes, please describe:
Q.) Have you ever been a charged perpetrator or appeared on any child abuse registry? Yes or No.
Q.) Please add any other certifications relevant for this position you may have.
Q.) Do you own a reliable vehicle, if yes what is the make, model & year of vehicle. *In order to be able to provide transportation or run errands, you will be required to have a valid driver’s license and current auto insurance. A Driver’s Abstract check will be conducted and proof of (Business) insurance will be required..
Q.) What day are you available to begin work?
Q.) Please list when you are available: Mornings, Afternoons, Evenings & or Weekends
Q.) Please indicate the days of the week as well as the earliest and lates times that you are available to work.
Q.) Please indicate all areas of the city or cities in which you are willing to work.
Q.) Please indicate the types of service which you are willing to provide: Companionship, Housekeeping, Errands, Shopping, Transportation, ElderCare Massage, Activities, Laundry, Medication Reminders
Q.) Are you willing to provide service to a client with a pet, yes or no. If yes, which one: Cats _______ Dogs______
Q.) Are you willing to provide service to a client that smokes? Yes / No
Q.) Please add any other certifications relevant for this position you may have.
Q.) I have documents that establish my identity and eligibility to work in Canada.
Q.) I can conduct business in written and spoken English.
Q.) By submitting this form, I agree to receive marketing and promotional emails and phone calls from CDN ElderCare and its franchisees at the contact information provided. I understand I can opt-out at any time. For more details, please refer to our Privacy Policy.
Q.) I agree to receive SMS text messages at the phone number provided. Message & data rates may apply. Reply STOP to opt out of further messaging.

* Caregiver Signature

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