Application Form

Part A. For office use only
Registration Date : ID# :
Your Email :
Affiliated Office :
Representative's Name :
Part B. Personal Information
Full Name :
Date of Birth : Gender : Male Female
Height : Weight :
Frame : Marital Status :
Nationality : Work Permit : Yes No
LCP : Live-in Canada : Yes No
Status in Canada :
Part C. Mailing Address
Address :
Apt. or Unit # : City :
Province : Postal :
Country : Major Intersection :
Part D. Phone
Country Code : Home ( Pls include area code if applicable ) :
Cell : Fax :
Part E. Work Related Information
Fluent Language(s) : speak read write
Native Language :
Do you drive? : How long (years)?:
Do you smoke? : Yes No Will you work on smokers house? : Yes No
Do you care for pets? : Yes No
Do you have a CPR/First Aid? : Yes No
Can you swim? : Yes No
Part F. Work Conditions
Type of shifts : Full-Time Part-Time Day-Shifts Night-Shifts Live-In Live-Out
Work Days : Monday Tuesday Wednesday Thurday Friday Saturday Sunday
Day(s) of week you go to church: : Monday Tuesday Wednesday Thurday Friday Saturday Sunday
Part G. Education / Training
Pls. Provide legitimate Institution or School name(s)
Description : 1 2
Name of Institution / School :
Type of Degree :
Specialization :
City :
Country :
From :
To :
Total Years :
Part H. Experience and References
Minimum of 2 references required
Description : 1 2
Employer Name :
Phone : ( ) - ( ) -
City :
Country :
Type of Care :
Duties and Responsibilities :
How Long :
Reason(s) for leaving :
Part I. Professional Expertise (Number of Years)
Nurse : Teacher :
Nanny of Child Care : Elderly :
Disabled : Housekeeper :
Type of Care that you would like to provide in Canada? :
Reason for choice :
Part J. Other Information
Spouse's Name : Relation :
Number of Children :
How are you going to care for your children while working :
Describe :
Part K. Cooking Skills
Type of you can cook :
Canadian / American Filipino Chinese Western
Please list other :
Style of cuisine :
Part L. Characteristics
Likes :
Dislikes :
Hobbies or Interest(s) :
Other Special Requirements :
Part M. Salary
Salary Requirements :
Canadian Dollar :
Amount $ :
Part N. Medical Status
Physician name: Dr. :
Phone: (Please include Area Code) :
Please describe specifically your Health or Medical status:

(Copy of medical examination required for overseas applicants)

Comments
** Very important! **
Please Fax or Mail or Bring in person copies of your original transcripts, diplomas, certificates, references with Referral Letter(s) and 3 photographs (passport size).

Mail to: Human Resources Department Can-Phil Immigration Services Inc. 307 -8055 Anderson Road Richmond, BC V6Y 1S2, Canada

Phone: (604) 274-6859 Fax: (604) 274-4367 Toll Free No. 1-888-796-8885


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