Mini-Minders Employment Application
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Date
Provider's Name
Spouse's Name
Mailing Address
Home Phone
E-mail
*required
Personal Assessment
Social Insurance no.:
Drivers License Number :
Number of Children at home :
Rent or Own the Residence :
How long have you lived there :
Questionnaire
What experience do you have in offering daycare?
Have you taken any courses relating to childcare?
Have you completed a first-aid course?
Are you currently providing daycare or registered with an agency?
Do you plan to offer daycare on a long-term basis?
Will other adults be present during the day?
Have your children's immunization shots been updated?
Would you object to a police check?
Will any additional children be in your care during the day?
Do you have any pets? Vaccinated and up to date?
Is this a non-smoking home?
Do you plan on using a car to transport children?
Who is your insurance carrier?
Any illness that may affect the care of other children?
Reference
Please list two references and their phone number not related:
Name
Number
Name
Number
Will you participate in training programmes:
Please list type of care interested in :
Full day or Half day?
Agreement
I hereby agree to the accuracy of the supplied information and give Mini-Minders consent to check the listed references. You will also be required to consent to a police check, medical and fire safety check in order to offer daycare.
Please type in security code as shown
WDDHS