Employment Application

PLEASANT VIEW HOUSING SOCIETY 1980

The Human Rights codes prohibits discrimination in employment because of race, national or ethnic origin, citizenship, religion, age, sex or sexual orientation, marital or family status, handicap, disability, language, or record of offenses unrelated to the employment being applied for. Pleasant View is an EQUAL RIGHTS EMPLOYER.

Personal

Last Name *

First Name *

Middle Initial

Street Address *

Apartment, suite, etc

City *

Province *

Postal Code *

Country

Contact Phone *

Other Phone

Email Address *

Position Applied For *

Advertised In *

Do you personally know anyone working at Pleasant View? *

YesNo

If yes, who?

Have you worked with us before *

YesNo

If yes, when?

Have you ever been interviewed for a job at Pleasant View Housing Society before? *

YesNo

If you have been interviewed, when?

and for what position?

What languages do you speak? *

What is your long term employment goal? *

What level of employment are you looking for? *

Full TimePart TimeCasual

Days and times available: *

DaysEveningsNightsShort Call

If hired, on what date will you be available to start work *

Are you legally entitled to work in Canada *

YesNo

General Health

Do you have any health concerns that might prevent you from working in the capacity of the position applied for in this facility? *

YesNo

If yes, please specify

Are you willing to abide by the Public Health Officer’s recommendations for immunizations such as influenza and COVID-19? *

YesNo

Are you currently fully immunized for COVID-19? *

YesNo

Are you able to provide proof of immunization for COVID-19? *

YesNo

Are you able to provide proof of immunization for influenza? *

YesNo

Emploment History

Organization #1

Position Held

From

Reason for Leaving?

Organization #2

Position Held

From

Reason for Leaving?

Organization #3

Position Held

From

Reason for Leaving?

Organization #4

Position Held

From

Reason for Leaving?

Have you listed all sources of employment in the past ten (10) years? *

YesNo

Education

Elementary/High School: Final grade completed

Year

College, Technical Institute or University

Name of Institution

Diploma/Degree/Credits

Dates Attended

Name of Institution

Diploma/Degree/Credits

Dates Attended

Name of Institution

Diploma/Degree/Credits

Dates Attended

Do you have a current Food Safe Certificate? *

YesNo

Date of Issue?

For Health Care Applicants Only

HCW Registry #

Do you have a certificate in mental health training?

YesNo

If yes, from what school?

If no, do you have direct experience working with adults with mental illness?

YesNo

If yes, number of years

Driver’s license, class 4 restricted or better?

YesNo

Are you a novice driver?

YesNo

Do you have a clean driving record?

YesNo

If no, explain

Do you have a valid first aide certificate?

YesNo

If yes, expiry date

References

Please provide names and position of present/previous employers or immediate supervisors whom we may contact for references.

Name *

Direct Supervisor? *

YesNo

If no, what is their relationship to you?

Organization *

Email Address *

Office Phone *

Cell Phone

Name *

Direct Supervisor? *

YesNo

If no, what is their relationship to you?

Organization *

Email Address *

Office Phone *

Cell Phone

Name

Direct Supervisor?

YesNo

If no, what is their relationship to you?

Organization

Email Address

Office Phone

Cell Phone

Declaration & Authorization

I consent to Pleasant View Housing Society collecting my personal information for the purposes of the Team Member-Employer relationship and to contacting my references above to help determine my suitability for employment.

I certify that the information given on this form as well as in my resume and any other supporting documents is complete and true. I understand that any misstatements or omission of facts will cause forfeiture of all rights to employment.

I have read and agree to the above statements *

All information is correct & complete to the best of my knowledge & belief.

Date

Please include a copy of your resume (Preferably as a PDF or Word document)

No file chosen