Living Assistance - Careers - Confidential Job Application Online Form


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Confidential Job Application Online Form

Click here for a printable Confidential Job Application Form or fill in and send the form below.

Instructions:
Please fully complete the following information to be considered for a home caregiver position with a client of Living Assistance Services. This information will remain confidential and nothing will be divulged which is not authorized by you.
Required fields are indicated with a red asterisk (*) - these must be completed to allow the form to be sent.

PART 1 - GENERAL INFORMATION
A.
Full Name of Applicant*:

B.
Full Address of Applicant:

Street No.*

Street Name*

Appt. No.

City*

Province*

Postal Code*

C.
Your Contact Numbers (incl. area code):

Home Phone*

Cell Phone

Email*:

Would you like us to contact you via email?* Yes No

D.
Do you drive?*
Yes No

E.
How long have you lived at the above address*:
Years* Months*

F.
If less than 5 years, provide old address:

Street No.

Street Name

Appt. No.

G.
Do you own or rent ?*

H.
If you rent, please provide telephone number of current landlord:

Landlord�s Name

Landlord's Day Tel. No.

Date Rented From

Rented Address & Apt. No.

PART 2 - EDUCATION

A.

School Name
Course Name
Degree Received?
Year Received

High School

Yes No

College/University

Yes No

Other/Specify

Yes No

B.
Have you received any other degrees, courses or certificates related to our business?* Yes No

If yes, please provide details.

PART 3 - EXPERIENCE

A.
Have you worked in this business previously?* Yes No

B.
Please provide the following information relative to previous employment:

Job Title
Employer Name
Employer Tel. #
From
To
Last Rate of Pay

PART 4 - REFERENCES

A.
Reference Type
Reference Name
Reference Tel. #
Relationship

Business #1*

Business #2*

Personal*

Other*

PART 5 - VOLUNTEER ORGANIZATIONS

A.
Please describe any volunteer positions you have experience with in non-profit agencies, places of worship, hospitals or other organizations, if any:

Organization
Type of Work
From
To

PART 6 - MISCELLANEOUS INFORMATION

A.
Please describe how many hours per week and the days and times you are available to work*:

B.
Please provide specific days and times you are unable to work, if any:

C.
Are you available for a live-in position?* Yes No

If so, which days are you available to work?

D.
Please provide us with the hourly wage required*:

E.
When are you available to begin work with Living Assistance Services?*

F.
Please describe any strengths which would make you a good candidate to be a Living Assistance Services Caregiver*:

G.
Please list languages other than English in which you are able to communicate*:

PART 7 - RESTRICTIVE COVENANT AND AUTHORIZATION

You agree, if hired, not to circumvent or bypass our rights by doing business directly with any business or individuals to whom we have introduced you, (or by entering into employment with such business activities or individuals), without our advance written consent.

The applicant hereby authorizes Living Assistance Services to check all information provided herein by the Applicant by whatever means available including, but not necessarily limited to, driving record, references and social insurance status, to determine suitability for employment.

It is further agreed and understood that any incorrect or inaccurate information provided herein shall constitute cause for non-employment or dismissal during the Applicants period of employment.

Date at Toronto, this* day of* , in the year* .
Name of Applicant*:

Anti-spam security question: What colour is grass?*
(This is to prevent use of the form by automated spamming programs)

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