Personal Support Worker Application

First Name	*
Last Name	*
Address	*
City	*
Province	*	Postal Code*
Country	*
Home Phone # (555-555-5555)	*	Cell #
E-mail Address
Re-type e-mail address

Main intersection closest to your home.	*
Where are you willing to work?	*	Downtown Toronto East York Scarborough North York York Region Durham Region Etobicoke

A person legally eligible to work in Canada is a Canadian citizen, a landed immigrant, permanent resident or a holder of a valid work permit.
Are you legally eligible to work in Canada?	*	Yes No
Have you ever been convicted of a criminal offence for which you have not been pardoned?	*	Yes No

Some positions require access to a car, valid driver's license and car insurance.
Do you use public transportation for work?		Yes No
Do you have access to a car?		Yes No
Do you have a valid driver's license and car insurance?		Yes No

Please indicate the position you are applying for		Personal Support Worker
Ideally how many hours per week would you like to work?
When are you available to Start?
Please indicate your availability.
Monday		Early Morning (6 am - 9 am) Late Morning (9 am - noon) Afternoon (Noon - 6 pm) Evening (6 pm - 11 pm) Over Night (11 pm - 7 am)
Tuesday		Early Morning (6 am - 9 am) Late Morning (9 am - noon) Afternoon (Noon - 6 pm) Evening (6 pm - 11 pm) Over Night (11 pm - 7 am)
Wednesday		Early Morning (6 am - 9 am) Late Morning (9 am - noon) Afternoon (Noon - 6 pm) Evening (6 pm - 11 pm) Over Night (11 pm - 7 am)
Thursday		Early Morning (6 am - 9 am) Late Morning (9 am - noon) Afternoon (Noon - 6 pm) Evening (6 pm - 11 pm) Over Night (11 pm - 7 am)
Friday		Early Morning (6 am - 9 am) Late Morning (9 am - noon) Afternoon (Noon - 6 pm) Evening (6 pm - 11 pm) Over Night (11 pm - 7 am)
Saturday		Early Morning (6 am - 9 am) Late Morning (9 am - noon) Afternoon (Noon - 6 pm) Evening (6 pm - 11 pm) Over Night (11 pm - 7 am)
Sunday		Early Morning (6 am - 9 am) Late Morning (9 am - noon) Afternoon (Noon - 6 pm) Evening (6 pm - 11 pm) Over Night (11 pm - 7 am)
Anything else you want to tell us about your availability?

In addition to English, please list all the languages you:
Speak
Understand
Write

Have you ever been employed by VHA?		Yes No
If yes:
Employment dates
From (mm/yyyy):
To (mm/yyyy):
What was your position?
What was your reason for leaving?

Attach cover letter	*
Attach resume	*

Where did you hear about this opportunity?
Other

Disclaimer:
By checking 'I agree' I certify that the information provided in this profile is true and complete to the best of my knowledge. I understand that a false statement or omission may disqualify me from employment, or cause my dismissal.
	*	I agree