Edmonton Application

Name

Phone Number

Country of citizenship:

Are you a permanent resident of Canada that can legally work in Canada?

Yes

No

Over 18 years of age

Yes

No

Have you applied with another agency?

Yes

No

Address

Postal Code

Name of Neighbourhood

What type of home do you live in? House Townhouse Duplex Mobile Home Apartment* *Must be ground floor

Do you own your home?

Yes

No

Do you have permission from your landlord to operate a dayhome?

I own my home

Yes

No

Do you have a yard?

Yes

No

Is your yard fenced?

Yes

No

Does anyone in your household smoke?

Yes

No

Other than yourself, how many individuals live in the home that are 18 years or older? (enter a number only) Please only enter a number (i.e. 0, 1, 2, 3) No text.

Do you have children of your own? (name and age)

Are you currently caring for children other than your own? (if yes, list ages)

Why are you interested in becoming a dayhome educator?

Are you committed to being a long-term quality educator?

Yes

No

When would you like to start your dayhome?

Work History

Education Level 1 or Child Development Assistant Level 2 or Child Development Worker Level 3 or Child Development Supervisor N/A Other (See Below)

Education Other

Have you ever been with another dayhome agency?

Yes

No

Languages spoken (other than English)

Do you have pets? If so, what kind and how many? Please specify...

Days available

Hours available

What play/child care equipment do you have?

Are you planning to use your vehicle to transport children?

Yes

No

What type of activities would you provide for the children?

List 5 examples of field trips you would take with the children and how you will get there

What form of child guidance do you use?

What ages of children would you prefer to care for and how many?

Where in your home will you be setting up your playspace? (must have a window)

How did you hear about us? Google Search or Google Ad Facebook Kijiji Friend Dayhome Provider Agency Sign Another Agency Government Website CanadaChildCareDirectory.com Was with your agency in the past Poster Newspaper YouTube Twitter Yelp School Alberta Health Services Other

Comments or Questions?

Email Address

Signature