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Mississauga Application Form

Complete the Mississauga Application to join our compassionate caregiving team and provide quality senior home care services in the community. Our Mississauga Application process helps experienced caregivers connect with families needing companionship care, personal support, hospital discharge care, and reliable in-home assistance .

Mississauga Application Form

Job Posting Reference

Applicant's Full Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

What is your gender identity? (Optional)

Male

Female

Non-Binary

Prefer not to say

Other

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

Referred By:

Have you worked with this agency previously:(Required)

Yes

No

If YES what year(s)?

How many years experience do you have in this industry?(Required)

Are you a Personal Support Worker?(Required)

Yes

No

Do you take public transportation?(Required)

Yes

No

Do you have your own vehicle for work?(Required)

Yes

No

Number of COVID Vaccines Received?(Required)

Do you have a current (within 1yr of this application date) Vulnerable Police Check?(Required)

Yes

No

Optional: Cultural Background

At Ideal Caregivers 4U, we value cultural compatibility as part of providing respectful, person-centered care. Some of our clients request caregivers who share a similar cultural or language background. This section is optional and is used only to support appropriate client-caregivermatches.

If you are comfortable, please let us know how you identify:

Black / African / Caribbean

East Asian (e.g., Chinese, Japanese, Korean)

South Asian (e.g., Indian, Pakistani, Sri Lankan, Bangladeshi)

Southeast Asian (e.g., Filipino, Vietnamese, Thai, Cambodian)

Indigenous (First Nations, Métis, Inuit)

Middle Eastern / North African

Latino / Hispanic

White / Caucasian

Prefer not to say

Other

Some clients may request a caregiver who speaks a particular language to ensurecomfort and clear communication. Please list all the languages you speak fluently orconversationally.

Documents

Documents Required to be emailed to us (if applicable):info@idealcaregivers4u.com Att: Mags

PSW Certificate

Any training certificates

CPR Certificate

First Aid Certificate

TB tests

Government photo Identification

Vulnerable Police Check

Previous Work History (2+ Years)

Company 1 Name

Company 1 Phone

Position

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Company 2 Name

Company 2 Phone

Position

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Company 3 Name

Company 3 Phone

Position

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Additional work history in the past 2+ years:

Professional References

Reference #1

First Last

Reference #1 Phone

Reference #1 Position/Relationship to you

Reference #2

First Last

Reference #2 Phone

Reference #2 Position/Relationship to you

Reference #3

First Last

Reference #3 Phone

Reference #3 Position/Relationship to you

Availability

Please state your availability below in as much detail as possible. Due to the nature of the business, no guarantee can be made as to the schedule, or the number of hours worked.

What date are you available to begin work?(Required)

MM slash DD slash YYYY

Weekdays/Times(Required)

Please indicate the days of the week that you are available and the exact times in the day that you are available so that we can schedule shifts accurately.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Monday Times

Morning

Afternoon

Evening

Overnights

Tuesday Times

Morning

Afternoon

Evening

Overnights

Wednesday Times

Morning

Afternoon

Evening

Overnights

Thursday Times

Morning

Afternoon

Evening

Overnights

Friday Times

Morning

Afternoon

Evening

Overnights

Saturday Times

Morning

Afternoon

Evening

Overnights

Sunday Times

Morning

Afternoon

Evening

Overnights

Are you willing to provide service to a client with a pet?(Required)

Yes

No

Which animals?

Cats

Dogs

Both

Are you willing to provide service to a client that smokes?(Required)

Yes

No

Areas willing to work:

Mississauga East

Mississauga West

Mississauga (Downtown)

Mississauga South

Your Full Legal Name

First Middle Last

Signature(Required)

Date Signed

MM slash DD slash YYYY

Contact Us

Toll-Free 1-866-372-0603

info@idealcaregivers4u.com

Client Registration

Oshawa & Whitby

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