A - Class Nannies & Caregivers Inc. © 1997 Canadian nanny and caregiver referral service that has provided alternative, affordable, qualified and experienced in-home care to Canadian families across Canada that requires childcare, elderly care, care for the disabled and care for special needs for temporary or permanent.

 

Online Family-Employer Intake Form

 

Hello and welcome to our Online Family-Employer Intake Form. Kindly complete the information requested below as accurately as you can. The information we request is private and confidential and its sole purpose is to assess your family's care needs.

 

Thank you.

 

Note: Please do not press "Enter" on your computer while completing the form. Pressing "Enter" will send the form automatically even if you are not yet done in completing the form. Press tab to go to the next question.

 

* field is required

 

Employer Information  

 

*Name:

  

*Last Name:

  

Contact Information  

*Current Address:

  

*Country:

  

*Home Telephone:

  

Work Telephone:

Cellular Telephone:

Email Address:

Other Contact Number:

Alternative Email Address:

 

Care Information  

 

Kindly choose below and provide as much information on the type of care that your family needs.

Childcare

  
 

 

Family Composition  

:
 Name of children age sex

interest

 hrs in school

 
*Please indicate if there are any allergies to any of the family members..  

Kindly provide additional information below, if the care needed is for special needs.
The level of care required for your child.

Would there be lifting required:

Would there be lifting equipment:

Indicate the height of the person:

Indicate the weight of the person:
   

Elderly Care, Care for person's with disability

  

 

Names of person to be cared for:

 

Sex

 

Age

 

Medical and Health Condition

Would there be lifting required:

 Would there be lifting equipment:

Indicate the height of the person:

Indicate the weight of the person:
Please indicate if there are any allergies to any of the family members.

 

Description of Home and Work Environment  

 

*Approximate size of your home in square foot:

  

*Number of bedrooms:

  

*Number of floors:

  

*Type of house:

 

*Is the home accessible by bus/public transit?

  

If yes, please indicate the distance of your home from the bus stop.

*Are there smokers in the home?

  

If yes, please indicate if smoking is permitted in the home. 

*Are there pets inside or outside the home?

  

If yes, please indicate the types of pet in you have.

  

Would the caregiver provide care for the pets?

  

If yes, please indicate the pet care responsibilities.

  
       
Employment Information  

  

 
Full-Time Part-Time Temporary Other   
  Live-In   Live-Out  
Nanny Caregiver Housekeeper Companion Home Support

  

*Indicate the start date for the employment.

  

*When would you be available to interview?

  
*Indicate the Gross Wage you would like to offer:  

*Would you be offering benefits (i.e. dental, medical) if any, not mandatory?:

  
       

Kindly indicate the days and the hours that you will require your nanny-caregiver to work and indicate "OFF" on the days you do not require the nanny-caregiver to work. For Split Shifts, indicate the same.

 
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
       
*Please indicate the housekeeping duties below. *Indicate the job description of the nanny-caregiver.
   
     
Accommodations for Live-In Nanny-Caregiver  

  

Private Room with a lock Private Bathroom Shared Bathroom TV/Cable
Telephone Radio Computer Internet

Others:

 

How did you learn about A - Class Nannies & Caregivers Inc? (Kindly choose the option that is applicable to you.)

Friend (Kindly enter your Friend's name.):

Internet Search (Kindly enter the Search Engine you used.): 

Telephone Directory (Pls. indicate the name of the directory.):

Internet Forum (Pls. indicate the name of the Forum.):

Others:
 

Terms and Conditions  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • I hereby certify that the above information provided on the Online Employer Intake Form is true and accurate to the best of my knowledge.

  • I agree and understand that by checking the box to the left and submitting this form, that I am under no obligation to employ a Caregiver from A - Class Nannies Inc.

  • I agree and understand that the Fees for the services provided by A - Class Nannies Inc. is a one (1) time fee of CAD $ 800.00 plus GST.

  • I agree and understand that in the event the Caregiver leaves you, the Employer, for insufficient reason or you, the Employer, ceases employment with the Caregiver, you, the Employer, are entitled to select a replacement at no additional cost within one (1) year from the start date of the initial employment of the first Caregiver.

  • I agree and understand that in the event you, the Employer, has employed a Caregiver that requires a work permit, A - Class Nannies Inc. shall assist you, the Employer, in obtaining Labor Market Opinion from Service Canada. However, you, the Employer, shall have the responsibility to cooperate with A - Class Nannies Inc. in providing documents and information that the Caregiver may need in obtaining a work permit to Canada. You, the Employer's, failure to cooperate with A - Class Nannies Inc. in providing required documents and information to the Canadian Embassy/Consulate/High Commission can lead to delays or even refusal for the Caregiver in obtaining a work permit to Canada.

  • I agree and understand that A - Class Nannies Inc. shall not be responsible for delays incurred due to government delays or requirements or delays due to non-compliance by the Caregiver and/or you, the Employer, in submitting related documents and/or information to Service Canada, Citizenship and Immigration Canada and/or Canadian Embassy/Consulate/High Commission. A - Class Nannies Inc. will do its best to ensure the Caregiver commences employment as quickly as possible.

  • I agree to discharge and hold A - Class Nannies Inc. innocent and shall not be held responsible for any acts that results in any items or goods stolen, lost or damaged during or after the course of this Contract. In addition, I agree to discharge and hold A - Class Nannies Inc. innocent and shall not be held responsible for any acts that results in any injuries, accident, illness, loss of life, loss of monies and loss of limb that may occur during the course of this Contract.

  • I agree and understand that the Contract with A - Class Nannies Inc. commences on the date the Caregiver commences employment with you, the Employer.

  • I agree and understand that A - Class Nannies Inc. provides a Guarantee for replacement for one (1) year. The Guarantee for replacement starts from the date the Caregiver starts employment for you, the Employer, and ends one (1) year after the start date of employment by the Caregiver to you, the Employer.

  • I agree and understand the Fees are applicable once you, the Employer, has selected a candidate from A - Class Nannies Inc.

  • I agree and understand that the Fees Schedule for A - Class Nannies Inc. requires an initial fee of CAD $ 350.00 plus GST from you, the Employer, once you have selected a Caregiver from the A - Class Nannies candidates and the remaining balance of CAD $ 450.00 plus GST is payable once the Caregiver starts employment for you, the Employer.

  • I agree and understand that the Fees are non-refundable and non-transferable.

  • I agree and undertake that A  - Class Nannies Inc. assumes no responsibility in withholding and remitting of any taxes required by law arising from the Caregiver's employment to you, the Employer.

  • I agree to discharge and hold A - Class Nannies Inc. innocent for any act of the Caregiver.

  • I undertake to release A - Class Nannies Inc. for any act of the Caregiver.

  • I agree and understand that by checking the check box to the left that I would be bound by the Terms and Conditions of A - Class Nannies Inc.

  • I agree and understand that A - Class Nannies Inc. shall terminate this Contract and Guarantees with you, the Employer, if you, the Employer, has breached and violated the Contract, Employment Standards Act and/or Immigration Refugee Protections Act and Regulation.

  • I agree and understand that I have read the above and the Terms and Conditions of A - Class Nannies Inc.

Kindly click to the box to your left.