Current Employment Title:
How Long:	How many hours per week:
Previous Employment Title:
How Long:	How many hours per week:
Previous Employment Title:
How Long:	How many hours per week:

Language: English
Speaking:	Listening:
Reading:	Writing:
Language: French
Speaking:	Listening:
Reading:	Writing:

Are you currently living in Canada? Yes No

If you are living in Canada, are you working as a Live-In Caregiver? Yes No

Do you have an employment offer with a caregiver sponsored employer in Canada?
Yes No

If "Yes", provide your Canadian employer's information (name, address & phone number.) (Note: An assessment without arranged employment in Canada will not be evaluated.)

Have you taken 6 months of full-time training in a classroom setting for a caregiver?
Yes No

If "Yes", describe your caregiver training in details (length, hours, training, etc.)

Any issues regarding medical and/or criminality?

How much savings do you have? (CAD)

How did you hear about Border Connections?