APPLICATION TO AARON AGENCY
(Check) To Hire A Nanny__Housekeeper__Home Care Provider__Other__
(Check) Caregiver Referral Service ____ (Or) General Caregiving Service ____
Please Print Clearly. Attach Any Additional Information on a Separate Sheet.
1. Name ____________________________________________________________
2. Addr _____________________________________________________________
3. Home Tel # ______________________________Work _____________________
4. Fax Tel # _____________________________ Cell ________________________
5. Email Address(es) _________________________________________________
6. Seeking A Nanny, Housekeeper Or? _____________________ LiveIn/Out? __
7. Start Date (M/D/Y) _____________________ Full/Part Time? ______________
Please State The Specific Days and Hours The Caregiver is Required to Work -
8. __________________________________________________________________
9. __________________________________________________________________
If Childcare is Required, Please State The Gender And Age of Each Child:
10. __________________________________________________________________
11. __________________________________________________________________
12. __________________________________________________________________
If Personal Care, Home Care, Elder Care, etc. is Required, Please Give Details:
13. __________________________________________________________________
14.__________________________________________________________________
15. __________________________________________________________________
16. Drivers Lic Req'd? _______ Vehicle Req‘d? ______ Vehicle Provided? _______
17. If Live In, Describe Living Quarters For Caregiver ________________________
18. __________________________________________________________________
19. __________________________________________________________________
20.__________________________________________________________________
21. Weekly Salary (Before Deductions) $ __________ In CDN Or US Funds? ____
Job Description: Duties, Type Of Caregiver Preferred, Other Comments, Etc:
22. __________________________________________________________________
23. __________________________________________________________________
24. __________________________________________________________________
25. __________________________________________________________________
26. __________________________________________________________________
27. __________________________________________________________________
28. __________________________________________________________________
29. __________________________________________________________________
30. __________________________________________________________________
31. __________________________________________________________________
32. __________________________________________________________________
IF YOU ARE APPLYING FOR GENERAL CARE GIVING SERVICES:
YOU WILL PAY NO REGISTRATION, APPLICATION OR REFERRAL FEES.
A CONTRACT FOR GENERAL CARE GIVING SERVICES IS OPTIONAL.
IF YOU ARE APPLYING FOR CAREGIVER REFERRAL SERVICES:
A CONTRACT IS REQUIRED. YOU WILL PAY A NON REFUNDABLE
APPLICATION FEE OF $250. UPON SUCCESSFUL PLACEMENT OF A
REFERRED CAREGIVER, YOU WILL PAY A SEPARATE NON
REFUNDABLE PLACEMENT FEE OF $250.00.
WITHIN CANADA = CDN $, OUTSIDE CANADA = US $
WE DO ACCEPT CASH, CERTIFIED CHECKS, TREASURERS CHECKS,
BANK DRAFTS AND BANK OR POSTAL MONEY ORDERS. IF YOU
ARE PAYING WITH AN UNCERTIFIED PERSONAL CHECK, THERE
WILL BE A WAITING PERIOD OF 15 DAYS FOR BANK CLEARANCE.
IF PAYING ONLINE USING A PAYPAL ACCOUNT OR CREDIT CARD,
33. SIGNATURE _____________________________________DATE ____________
Click Here To View Or Print Our Contract (For Referral Service Only)
AARON AGENCY
5594 Northridge Road, Suite 1, Halifax , Nova Scotia , Canada B3K 4B1
Tel: Halifax , Nova Scotia , Canada (902)406-5146
© 2005-2010. ALL RIGHTS RESERVED.