Applicatioon Forms

My Special Nanny Home Daycare - Oakville

Applicatioon Forms

	HOME	About Us \| Program Statement \| News and Events \| Directions \| Contact Us \| Applicatioon Forms

Provider Application

Name
Street Address


City
Province
Postal Code
Home Phone Number
Closest Intersection
Date of Birth
Social Insurance Number
Languages Spoken


Do you have children?	Yes
Do you have children?	No
Ages of Children
Does anyone else live in your home?	Yes
Does anyone else live in your home?	No
If yes, please give details
Do you have pet(s)?	Yes
Do you have pet(s)?	No
If yes, please give details
Do you or anyone else in your household smoke?	Yes
Do you or anyone else in your household smoke?	No
What are your reasons for wanting to be a Home Daycare Provider?
Please list childcare experiences
Do you have First Aid or CPR training?	Yes
Do you have First Aid or CPR training?	No
Do you want
Are you willing to have a Fire, Police and Health Inspection?	Yes
	No
Are you willing to attend agency workshops?	Yes
Are you willing to attend agency workshops?	No
Why do you wish to join an agency?
How did you hear about My Special Nanny?
Professional Reference #1
Address
Phone #
Professional Reference #2
Address
Phone #
Personal Reference
Address
Phone #
Today's Date

Nanny Application

Name
Street Address


City
Province
Postal Code
Home Phone Number
Closest Intersection
Date of Birth
Social Insurance Number
Languages Spoken


Do you smoke?	Yes
Do you smoke?	No
Do you drive?	Yes
Do you drive?	No
Do you have your own car?	Yes
Do you have your own car?	No
Do you swim?	Yes
Do you swim?	No
What are your reasons for wanting to be a Nanny?
Please list childcare experiences
Do you have First Aid or CPR training?	Yes
Do you have First Aid or CPR training?	No
Would you prefer to work as a
Are you willing to provide us with a Police Clearance?	Yes
Are you willing to provide us with a Police Clearance?	No
Are you willing to attend agency workshops?	Yes
Are you willing to attend agency workshops?	No
Why do you wish to join an agency?
How did you hear about My Special Nanny?
Professional Reference #1
Address
Phone #
Professional Reference #2
Address
Phone #
Personal Reference
Address
Phone #
Do you play any musical instrument?	Yes
Do you play any musical instrument?	No
Do you have any special skills?	Yes
Do you have any special skills?	No
Please specify
Are you allergic to pets?	Yes
Are you allergic to pets?	No
Are you willing to do household chores?	Yes
Are you willing to do household chores?	No
Days available to work	Mon
	Tues
	Wed
	Thurs
	Fri
	Sat
	Sun
Which area would you prefer to work?
Do you want a
When was your last medical check-up?
Today's Date