Canada Atlantic Caregiving Solutions
Quality Placements For Canadian Families
Live-In                 Live-Out               Part-Time
 
Please Phone (506) 693-0042 For More Information

Please fill in the following form if you wish to hire one of our caregivers or if you would like us to help you with choosing one.

Employer Application Form

Required Fields **
** First Name:

** Last Name:

Street Address:

** City/Town:

 ** Province:                            

** Postal Code:                      

** Telephone Number:        

Email Address:                    




** What type of caregiver do you require?
Nanny ElderCare Disabled/Special Care Companion

** Do you have a private and furnished bedroom for the caregiver/nanny?
Yes No

How many children do you have?
None One Two More

** Do you allow smoking in your home?
Yes No

** What is the gender(s) and age(s) of the individual(s) requiring care?
** Please describe the main duties of the caregiver:
Please describe any special features of the caregiver's living area:
Other comments that might be helpful to us in assisting you:

Although there isn't any obligation to hire a caregiver, by submitting this form, you agree that you have read and understand the Terms & Conditions

  
Canada Atlantic Caregiving Solutions
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