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Staff Only Area
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Career Opportunities
Application Form

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Personal Information
Date:
First Name:
Last Name:
Middle Initial:
Address:
 
City:
Province/State:
Posta/Zip Code:
Phone: ( ) -
 
Job Information
Job(s) applied for:
Do you want to work... Full Time   
Part Time
Casual
Do you want to work on... Days   
Evenings
Nights
Weekends
How did you learn about this job?
 
Educational Information
Are you legally entitled to work in Canada? Yes   
No
What languages do you speak?
What languages do you read & write?
Are there any health reasons why you could not perform the duties of the job, or for which you would require accommodation? Yes   
No

If yes, please explain:
Schools Attended: 1.
2.
3.
Course: 1.
2.
3.
Diploma/Degree: 1.
2.
3.
RN'S, RPN'S, LPN'S: 
Are you currently registered?
Yes
No
 
Work History
Job 1
Employer:
Position:
Address:
 
Phone: ( ) -
From: to
Supervisor:
Salary:
Reason for Leaving:
Job 2
Employer:
Position:
Address:
 
Phone: ( ) -
From: to
Supervisor:
Salary:
Reason for Leaving:
 
References
Reference 1
Name:
Occupation:
Address:
 
Phone: ( ) -
Fax: ( ) -
Reference 2
Name:
Occupation:
Address:
 
Phone: ( ) -
Fax: ( ) -
Reference 3
Name:
Occupation:
Address:
 
Phone: ( ) -
Fax: ( ) -
PLEASE READ CAREFULLY BEFORE SUBMITTING:
I understand that any information found on this form to be knowingly false or omitted may be cause for termination. I understand that a physical examination may be mandatory and that my employment may be dependent on the results of this examination.  I understand that a 2-step Mantoux Test or documentation of TB Infection status is mandatory and must be submitted within 4 weeks of hire.  Follow-up will be required if my TB infection status is positive.  This test/documentation is a condition of hire and is at my expense.

I will provide Donwood Manor with a current Personal Request for Criminal Record Search at my expense within three weeks from date of hire.  I give my permission to conduct reference checks in connection with my application for employment.

I understand that all information concerning residents, physicians, volunteers and other employees is to be held in the strictest confidence and that breach of Donwood Manor's confidentiality policy may be grounds for dismissal.