Application: CAREGIVERS OUTSIDE OF CANADA

I. Personal Information
First, middle & last name:*
Please enter your full name as seen on your passport.
First Middle Last
Family name at birth:*
Please enter your last name at birth.
Last
Gender:*
Citizenship / Nationality:*
Please upload of a photo of yourself:*
The photo that you upload should be a clear one of your face. We recommend that you upload one where you are smiling, and make sure the background is not too busy.
For best results, PLEASE CROP YOUR PHOTO TO BE SQUARE.
Accepted file types: jpg, jpeg, png, Max. file size: 10 MB.
Email address:*
Enter Email Confirm Email
Your phone number:*
Referred by (enter their full name):
Phone number of referral:
Your date of birth:*
Month
Day
Year
Marital status:*
Date of marriage or common law:*
Month
DD
Year
Do you have children?*
- Yes
- No

Please list your children below:

If you have a child or children, please select their gender and age below. Click on the + and - button to add or remove children.

Gender of child:	Age of child:

III. Work Experience
Total number of years as a domestic helper (DH)/caregiver?*
How many employers have you worked for as a DH/caregiver?*
Number of years working for your current employer?*
When does your current contract end?*
Month
Day
Year
In your current contract, you are caring for:*
Please select all that apply.
- a family with children
- an elderly person
- a disabled person
Please explain your current tasks below:*
Have you ever worked in any other country other than your country of citizenship?*
- Yes
- No
This field is hidden when viewing the form
Have you ever worked in any other country other than your country of citizenship?

List the countries:

Please click on the + and - button to add or remove years worked in other countries.

Country of work	From	From Year	To	To Year	Job Title

I. Personal Information