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CHILDCARE REFERENCE

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CHILDCARE REFERENCE Powered By Docstoc
					                                                                                          Canadian Work Opportunities

                                      CHILDCARE REFERENCE

All references must be translated into English on this form with the original attached.
Please type or write clearly on this form using black ink.
 Name of applicant: ___________________________________________________________________
 Name of person providing reference: _____________________________________________________
 Telephone: ________________ Best time to call: ____________________ E-mail: ________________
 Street Address: ____________________________________ City/State: ________________________
 Postal code _______________ Country: __________________________________________________
 How long have you known the applicant? _________________________________________________
 In what capacity do you know the applicant*? (employer, friend, neighbor) _______________________
 How long have you employed the applicant as a childcare giver? ______________________________
    Dates of     Ages of Children                                Responsibilities
     Care             (when the
                                         (e.g. bathing, playing, change diapers, help with homework, other
 From         To   supervision began)
                                                                            activities)




 Please describe the applicant’s personality: _______________________________________________
 __________________________________________________________________________________
 Why would you recommend/not recommend the applicant for placement as a Caregiver? __________
 __________________________________________________________________________________
 Signature _______________________________________ Date ______________________________

*Please note: people related to the applicant may not provide a mandatory reference but CAN provide an additional
reference for you!)

				
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