JINKHOLM INTERNATIONAL INC.
Your alternative to Daycare, Nursing Homes, Clock-watching Care-givers
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Employer Questionnaire


Date Required

Personal Information

Last Name

 
First Name  
   
Address
Home Phone
Suite/Apt #
Town
Work Phone
Province  Email Address
Postal Code
   
Care Needed
Type of care-giver required
Age preferred
Care Provided to  
   
Number of People

Enter the name and ages of all of the people who require the care-giver's services.
i.e. John Smith/12 (one person per line)

Care Givers Duties      
.


 
Assistance Required
to/from school
 Yes No  
Car Provided Yes  No  
Pets Yes  No If yes please specify  

  		   
Days Per Week:
(Mon-Fri)
(Tues-Sat)


(other)

Hours Per Day  am  to  pm
 
Facilities Room    
  Bath    
  Kitchen  
  Own Entrance  

 
 Telephone:
 1-866-245-6869
 (416) 635-1699
 (Toronto)

 Fax:
 (416) 635-1456

Designed By
Oliver Nelson
Jinkholm International Inc.  333 Wilson Ave.  Suite 503  M3H 1T2  Toronto, Ontario Canada