OVERSEAS CAREGIVER REGISTRATION
A. CONTACT INFORMATION
First Name:
Middle name:
Last Name:
Present address:
Permanent address:
Phone number at permanent address:
Current phone number:
Cell number if different from above:
Email address:
Passport no:
HK ID no:
Person to contact in case of emergency:
Relationship:
Emergency contact telephone number:
Emergency contact address:
 
B.  PERSONAL DATA
Date of birth:
Citizenship:
Place of birth:
Height:
Weight:
Marital status:
Name of spouse:
Age of spouse:
Occupation of spouse:
Number of children:
Name Gender Date of birth
Father’s name:
Father’s occupation:
Mother’s name:
Mother’s occupation:
Parent(s) address:
Number of siblings:
Name Gender Date of birth
Current country of residence:
Religion:
Does your religion prevent you from working on weekends? If yes, please provide details:
Yes No

Languages or dialects you can speak:
Languages or dialects you write:
How well do you speak English
Very Well Good Fair Poor
How well do you understand English
Very Well Good Fair Poor
How well do you write English
Very Well Good Fair Poor
Have you ever been arrested? If yes for what?
Yes No

Do you smoke?
Yes No
Do you drink or use mind-altering drugs? If yes, please explain.
Yes No

Do you swim?
Yes No
Do you feel comfortable supervising children in water?
Yes No
Can you ride a bike?
Yes No
Do you have a valid driver’s license?
Yes No
Are you particular about food? If yes, please explain.
Yes No

Are you willing to care for pets?
Have you had a pet of your own? If yes, please describe.
Yes No

Do you have allergies of any kind including to foods, drugs or animals? If yes, please give details.
Yes No

Do you have health conditions that could potentially interfere with your work? If yes please give details.
Yes No

How many days of work have you missed in the last year due to illness?
Are you currently on any prescription medicines? If yes, please list drugs and conditions they address.
Yes No

Do you require glasses or contact lens?
Yes No
If you’ve said yes to the above, is your prescription up to date?
Yes No
Is your hearing sound?
Yes No
C. EDUCATION AND WORK EXPERIENCE
High school attended:
Date graduated:
College or University attended:
Degree(s) completed:
Date graduated:
Vocational:
Date graduated:
Other courses and dates of completion:
Please list any additional skills:
Have you worked as a caregiver before?
Yes No

Employment (chronologically from present)

  
1. Job Title:
Job Description:
Job Duration:
2. Job Title
Job Description:
Job Duration:
3. Job Title:
Job Description:
Job Duration:
 
D. EMPLOYMENT EXPORATION
Will you work with children?
Yes No
How many are you capable of caring for?
What experience do you have taking care of Newborns (0 to 3 months)? Give details including feeding, changing, bathing etc.
What experience do you have taking care of babies (4-12 months)? Give details
How do you think you can assist with a child’s growth and development?
How do you think you can assist with a child’s education?
What experience do you have in taking care of children who are one year and older? Give details.
How do you think you can assist with the child’s growth and development?
How do you think you can assist with the child’s education?
What indoor activities do you enjoy with children?
What outdoor activities so you enjoy with children?
How would you handle the following situations?
  
Temper tantrums
Colic or fussiness
Sick child
Medical emergency
Sibling rivalry
How would you discipline a child?
What age groups are you willing to care for?
What experience do you have taking care of a disabled person? Give details including gender and age.
How do you think you can contribute to the quality of life for a person with disabilities?
What experience do you have taking care of an elderly person? Give details including gender and age.
How do you think you can contribute to the quality of life for an elderly person?
Do you have child or eldercare training? If yes, please describe
Yes No

Do you have first aid training? If yes when did you take it last?
Yes No

Are you willing to update your first aid training if needed?
Yes No
Do you have CPR training? If yes when did you take it last?
Yes No

Are you willing to update your CPR training if it is needed?
Yes No
What other skills do you possess?
Describe your experience with chores in the house
Can you cook?
If yes, please list up to 10 dishes that you can cook
Yes No

Can you bake? If yes, please describe what you can bake
Yes No
Are there domestic chores that you will not do?
If yes, please explain.
Yes No

E. SELF REFLECTION
Why do you want to come to Canada?
What are your expectations about your job in Canada?
Are you willing to work anywhere in Canada? If no, please explain.
Yes No

How does your family feel about your decision to come to Canada?
What are your personal interests and hobbies?
Why should an employer hire you?
What do you enjoy most about your job?
Describe your habits including optimal time of day for you. When you typical like to rise to start your day and when you typically like to go to bed
Write about an incident in your life that best tells something about your character.
How do you cope with stress and burnout?
Please tell us a little more about your family
How were you disciplined as a child?
What is the most difficult thing you have to do in your current or last job?
What are the two most important characteristics of an employer for you?
What do you think will make you uncomfortable in the workplace?
Are you willing to work flexible hours?
If no, please explain.
Yes No

What are your long-term goals?
Are you athletic?
Yes No
How do you think you will cope with long cold winters in Canada?
Please describe a typical day for you in your present job.
Do you have a serious boyfriend? If yes where does he live?
Yes No

How would you handle a situation of tension with your employer?
What are the two most important things to you while living in an employer’s home?
Would you be comfortable working with an employer who stays at home?
Yes No
Do you have friends and relatives living in Canada? If yes please give details.
Yes No

What do you consider to be the most important thing when choosing a job?
What makes you happy?
What type of commitment can you make to a new employer?
Are you prepared to travel with the family?
Yes No
Choose your top FIVE attributes  
Likeable
 Competent
Cooperative
 Helpful
Observe confidentiality
 Outgoing
Tactful
 Team player
Trustworthy
 Cheerful
Common sense
 Confident
Consistent
 Dependable
Loyal
Positive
Practical Professional
Sense of humor Ambitious
Energetic Enjoy challenges
Adaptable Creative
Resourceful Self-motivated
Take initiative Versatile
Quick learner Sound judgment
Able to prioritize Efficient
Methodical
 Precise
Punctual Bold
Well groomed Well organized
Choose a category that fits you best
(note: while many of us has a bit of more than one of these please place an X next to the number that describes you best.)

 
Systematic; Perfectionist; Steadiness; Cautious
Dominant; Common Sense;Powerful; Leader
Dependable; Considerate;Peaceful; Innovative
Spirited; Popular; Influencing; Dynamic
Is there anything additional you would like me to know? If yes, please explain.
Yes No

Are you aware of your rights and privileges as a temporary worker in Canada? If no, please describe in information you would be interested in.
Yes No

Is there additional information you would like from ProComfort Care Inc. If yes, please describe.
Yes No

F. EMPLOYER INFORMATION
1. Current or most recent employer  
Name of Employer:
Address:
Telephone Number:
Length of Employment:
Duties:
Number of people in your care & ages:
Reason for leaving:
Is your employer aware that you are seeking other employment? If no, please explain
Yes No

2. Previous Employer  
Name of Employer:
Address:
Telephone Number:
Length of Employment:
Duties:
Number of people in your care & ages:
Reason for leaving:
3. Previous Employer  
Name of Employer:
Address:
Telephone Number:
Length of Employment:
Duties:
Number of people in your care & ages:
Reason for leaving:
   
G. REFERENCES

Please provide three references who can be contacted by phone.
References should be able to speak English with confidence and at least one
reference should be knowledgeable about your current work situation.
1. Name:
Occupation:
Address:
Phone Number:
Relationship:
2. Name:
Occupation:
Address:
Phone Number:
Relationship:
3. Name:
Occupation:
Address:
Phone Number:
Relationship:
 
  • Please attach resume to application:

  • If possible please attach or send a photo of yourself:

  • Please keep an electronic copy for your records and email a copy of the form once completed to clientservices@procomfortcare.com

I hereby certify that all the information set forth in the above application
is true and accurate.