Job Application Form

  • Which Living Assistance Services location would you like to apply to?

  • Please select an option from the dropdown.
  • Personal Information

  • Tel:

  • Email:

  • Are you legally entitled to work in Canada?

  • Education

  • College/University

  • Other/Specify

  • Other/Specify

  • Please check any of the following certifications you currently possess.

  • Expiry Date (if applicable)

  • Restrictions

  • Work Limitations:

  • If the above answer is "yes", then:

  • Availability for Work

  • Hours & Days Available for Work:

  • Please note: Live-in care usually requires that you live in a client’s home continuously for 2-5 days at a time every week. For Live-in work please indicate which days you will accept:

  • Indicate Days and List Hours Available for Work for live-out and/or shift work:

  • Sunday

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday

  • Saturday

  • How much lead-time do you require before going out on a suddenly needed assignment?

  • Client Types and Work Duties

    Clients NOT Willing/Able to Work With:

  • Duties NOT Willing/Able to Perform:

  • Experience:

  • How would you rate yourself on your experience with the following aspects of caregiving?

    1 = No Experience 2 = Some Experience 3 = Good Experience 4 = Excellent Experience:

  • Assignment Location:

    Are you restricted in the geographical location you are willing/able to work?

  • Transportation

    Type Available

  • Drivers:

    If requested are you able to provide us with a driver's abstract?

  • Do you have any convictions under the Highway Traffic Act?

  • Criminal Background Check

    Have you been convicted of a criminal offence for which a pardon has not been granted?

  • Voluntary Positions

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

  • Employment History & Reference Details

    (Starting with the most recent job)

    Employment Reference #1

  • Employment Reference #2

  • Employment Reference #3

  • References

    Professional Reference:

  • Character Reference:


    Living Assistance Services is an equal employment opportunity employer dedicated to a policy of non-discimination in employment upon any basis, including race, color, creed, religion, age, sex, national origin, ancestry, sexual orientation, marital status, military status, or the presence of any non-job-related medical condition of handicap.

    Please keep in mind that the questions contained in this application are not intended to be discriminatory based on any non-job-related information.

    We want you to know that we will be checking your references as part of our hiring process. This may include contacting your former employers, as well as friends, acquantances and business associates. We may ask a series of questions about your personal background, work experience, character, education or personality.


    I have read and fully understand the foregoing and voluntarily consent to allow Living Assistance Services to check my references by contacting any person whom they deem to be an appropriate reference. Questions may be asked about my personal background, work experience, personality, personal habits and education.

  • Authorize my prior employer(s):

  • To release any and all information relating to my employment with Living Assistance Services.

    I further release and hold harmless the above mentioned employers and Living Assistance Services from any and all liability that may potentially result from the release and/or use of such information.

    I understand that any information released by my prior employer will be held in strictest confidence, that it will be viewed only by those involved in the hiring decision, and that neither I nor anyone else not so involved will have the right to see the information.

    *We thank all candidates for their interest in Living Assistance Services.

    Please note that only those considered will be contacted for an interview.