LIVE-IN CAREGIVER CONTRACT (Sample Contract) 1. Employer: 2. Employee: Name Name Address Address Tel. # Home 3. Order of Employment Work Revenue Canada Employer #: Job Title: Live-in Caregiver A) Job Description Child Care Yes Elderly No Yes Number of Children No Age of Children Disable Yes No Care Responsibility Duties Describe: Housekeeping Responsibilities Yes No Describe: Laundry for family, Make beds for family, Clean up dishes after preparing meals for family, Care of kitchen, Ironning, Vacumming, Dusting, Clean own bedroom and bathroom, Other tasks that are mutually agreed upon. Will employee be required to provide pet care? Yes No Additional Responsibilities Describe of house and household (number of room, household members, etc.) B) Yes No Wages and Working Conditions: Wages and working condition must reflect provincial employment standard and prevailing wage rates Net Pay $CND Hours of work Weekly Schedule of hours Monthly Days off (Which days of ?) . Frequency of pay . /wk /wk Overtime rate /hr To be paid after hrs The employer agrees to provide the employee with information regarding wages and types and approximate amount of deduction from pay. New Year's Day, Good Friday (Easter), Victoria Day, Canada Day, Labour Day, Thanksgiving, Christmas Day and Boxing Day Weeks of vacation with pay 2 /yr. Paid general holidays Other leave Days of paid sick leaves Cost of room and board 85.25 /w To be paid weekly biweeky /yr semi-monthly monthly Accommodation Finish private room ✘ Yes No Locked Medical Coverage Hospital and Medical Care Insurance Airfare included Yes ✘ No Yes No Other Benefits Private Bath ✘ Yes EI, CPP & Old Age Security Details ✘ Income tax deductions will be taken at source ✘ Contribution will be made by employer to Canada Quebec Pension Plan and to Unemployment Insurance Duration of employment 2 4 Terms and Separation: The employer and employee agree to abide by provincial labour standards regarding written notice of termination of employment (It is recommended that a copy of the relevant portions of provincial labour standards be attached as an appendix.) Amendment to this contract must be made in writing and agreed to by both parties. 5 No Signature of Employer 6 I certify the duties outlined above are accurate and correct I will abide by provincial labour standards. I will provide a Record of Employment on termination of employment Signature FCIS-L-IN-C-C Date: Signature of Employee: I have read the undertaking and understand it Signature Date: