JOB APPLICATIONDate available Position (select all that apply) *ActivityDietaryHousekeepingMaintenanceRNLPNHCAOtherType (select all that apply) *Full TimeCasualPart TimeWhich work schedule do you prefer? *DaysEveningsNightsAre you available to work weekends? *YesNoHave you already worked here? *YesNoIf yes, in which department were you employed? Last Name *First Name *Telephone # *Email Address: *Address *Town/City *Postal Code *Are you fully vaccinated against COVID-19? YesNoAre you comfortable wearing a mask or other personal protection equipment during your shift? YesNoAre you a minor? (under the age of 18) *YesNoRegistered Nurse YesNoLicensed Practical Nurse YesNoManitoba Registration No. Health Care Aide Certificate YesNoName of the institution in which you have received your diploma/certificate Can you legally work in Canada? *YesNo EDUCATION *HIGH SCHOOLCOMMUNITY COLLEGEUNIVERSITYOTHERMajor or highest level finished Certificate, diploma obtained LANGUAGESFRENCH *SpokenReadWrittenENGLISH *SpokenReadWrittenOTHER SpokenReadWritten EMPLOYMENT HISTORY – Below, please fill out your employment history beginning with the most recent.Name and address of company # 1 Telephone From To Please give the reason why you left Name of your supervisor Please describe your tasks on a regular day Full timePart timeName and address of company # 2 Telephone From To Please give the reason why you left Name of your supervisor Please describe your tasks on a regular day Full timePart timeName and address of company # 3 Telephone From To Please give the reason why you left Name of your supervisor Please describe your tasks on a regular day Full timePart timeName and address of company # 4 Telephone From To Please give the reason why you left Name of your supervisor Please describe your tasks on a regular day Full timePart timeThe Villa Youville may contact my previous employers concerning my employment. Employer # 1 YesNoEmployer # 2 YesNoEmployer # 3 YesNoEmployer # 4 YesNoPlease indicate a short summary of all other experiences and/or abilities you possess that would be an asset in the position you are applying for. THE INFORMATION GIVEN IS TRUE AND COMPLETE. I UNDERSTAND THAT IF I AM HIRED, FALSE INFORMATION GIVEN OR HIDDEN INFORAMTION WILL BE SUFFICIENT GROUNDS FOR DISMISSAL Date Name of candidate VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
