To register with Family Care Canada, please fill out the following form with as much detail as possible.
AGENTS: Please make sure to request an agent code when registering for the first time.

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My Location:
I Am Looking For:
I Specialize In:
Choose your picture:
Personal Information
First Name:
Last Name:
Address:
City:
State:
Postal Code:
Current Address:
Current Country:
Phone #1:
Phone #2:
Fax #:
Email:
Date of Birth:
Gender:
Nationality:
Religion:
Passport Number:
Passport Expiry Date:
Date your current work permit expires (if in Canada): (mm/dd/yyyy)
Date you're available to start work: (mm/dd/yyyy)
Marital Status:
Number of Children:
My Children's Ages: (ie. 5,7,11)
Do You Have Any Siblings:
Where are you in the birth order?
Languages Spoken:
I would like to work with...
Do you have any serious allergies?
If yes, please explain:
Do you smoke?
Do you drink alcohol?
How is your general health?
Do you have any physical or mental illnesses?
Do You Swim?
Do you drive?
Do you want to drive in Canada?
Have you ever been convicted of a criminal offence?
Are you willing to work for a single parent?
Will you take full charge in your employer's absence?
Will you work with domestic animals (dogs/cats)?
Can you cook?
If yes, what kind of food?
Caregiver / Nanny Education
Highest Level Of Education:
Year of Graduation:
Diploma/Degree Earned:
English Speaking Skills:
English Writing Skills:
English Reading Skills:
Do you have six months of full-time caregiver
training in a classroom setting?
Are you certified to perform CPR?
Are you certified to perform First Aid?
Please list any additional education you have:
Caregiver / Nanny Work Experience
Employers Name:
Employers Country:
Position:
Date Started: (mm/dd/yyyy)
Date Finished: (mm/dd/yyyy)
Children/Elderly Ages:
Duties and Responsibilities:
Reason for leaving:
Childcare Experience
Total number of years of experience:
Age groups of children you took care of: 0 - 8 Months
9 - 18 Months
19 - 24 Months
2 - 4 Years Old
5 - 6 Years Old
7 - 10 Years Old
11 - 12 Years Old
13+ Years Old
Do you have any experience with infants:
Please explain your duties and responsibilities relating to the children:
What is the maximum number of children you can take care of:
Can you care for children with special needs:
Are you willing to take care of a special needs child:
Do you have experience in dealing with the disabled:
Elderly Experience
Do you have experience caring for the elderly?
If yes, how many years?
Are you experienced in administering medication?
Do you have experience in dealing with the disabled?
Describe your experience
(age and condition of the person, your daily duties, etc):
For The Employer
List your hobbies:
Do you play musical instruments?
if yes, which one(s)?
Why will you make a good caregiver?
How would you describe your personality?
Agents Only
Agent Code:

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