Replacement Agreement
Qualifications

 

   Employer's Order  

In order for us to give you the best service please complete
this form & email, fax or mail it to us.
First name
Family name
Address
City
Province
Postal code
Home phone
Work phone
Fax
Email
Occupation
Name of spouse (if applicable)
Occupation
1. When do you need a nanny to start?
2. Do you need a nanny as
 Live-in Llive-out
3.Salary offered
4. Do you want nanny portfolios to be
Mailed Faxed

6. Is there any of your children that require special care or any kind of needs? If yes, (please specify)

7. Tell us about your children:
 
Name/ Birth-date/Age/Sex/
Grade(if in schoo)l
8. Is a new baby expected?
9. Is evening baby-sitting required?
If yes how often?
10. Do you have any pets?
No Yes
If yes, please provide duties required

11. Description of duties involves in care of children
(please check where applicable)

Prepare meals:

 Breakfast Lunch Dinner Snacks

 

Care for 1-2 year old:
Prepare formula  Bath Changing diaper Dressing
Home-prepared baby food Toy pick up Day feeding
Night feeding Other(please specify)

 

Care for 3-5 year old:
Prepare meals Toilet training Dressing Bedroom clean-up
Feeding Toy pick up Taking children for walk
Laundry Reading stories

 

Care for 6-12 year old:
Prepare meals Laundry Bedroom clean-up
Reading/telling stories Other(please specify)

 

12. Description of duties involved in care for elders:
Prepare meals:

Breakfast Lunch Dinner Snacks

Assistance:
Dressing Bath Toilet Mobility
Other(please specify)

 

13. Description of other house holds duties for caregiver 

Vaccuming Laundry Ironing Groceries
Dusting Waxing furniture Setting table
Answer doors & telephones Other(please specify)

14. Please provide details of caregiver works schedule.(Hours of work, shifts,
weekends, holidays &other)
15. Do you require your caregiver to drive?
Yes No
If yes, are you willing to teach or provide a driving lesson?
16. Do you require your caregiver to be able to swim?
Yes No
17. Do you require your caregiver to take a
first aid course?
 Yes No
If yes are you willing to pay for the course? Yes No
18. Will the caregiver be allowed visitors?
Yes No

19. Please give us a brief description of the caregiver accommodation
in your home.

20. Please give us a brief description
of your family
life style.

21. List qualities that you are
looking for a nanny.
22. How many nannies have you
employed in the past?

23. Where did you hear about Queeny international nanny Agency?