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Application Form

This document is an application for employment at Leisureworld. It requests personal information like name, address, and contact details. It asks if the applicant is legally eligible to work in Canada and if they have any criminal convictions. The applicant must provide information on their availability, locations of interest, education history, and previous employment. The applicant agrees that any offer is contingent on references and background checks. They also acknowledge annual medical exams may be required.

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Jenny Gapas
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
191 views

Application Form

This document is an application for employment at Leisureworld. It requests personal information like name, address, and contact details. It asks if the applicant is legally eligible to work in Canada and if they have any criminal convictions. The applicant must provide information on their availability, locations of interest, education history, and previous employment. The applicant agrees that any offer is contingent on references and background checks. They also acknowledge annual medical exams may be required.

Uploaded by

Jenny Gapas
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

APPLICATION FOR EMPLOYMENT

Only applications completed in full will be reviewed, please ensure you print clearly.
PERSONAL DATA:
Name: (First and last) ____________________________________________________________________________

Full Address: (#, Street, Apt., City, Province, Postal Code) _______________________________________________

______________________________________________________________________________________________
Phone Number: (Daytime) ____________________________ (Evening) _________________________________

Are you legally eligible to work in Canada? ο Yes ο No

Have you ever been convicted of a criminal offence for which you have not received a pardon? ο Yes ο No
Have you been employed by Leisureworld before? Yes No ο ο
If yes, where ____________________________________________________________________________________
Are you the spouse, parent or child of a current Leisureworld employee? ο Yes ο No

If yes, Who: __________________________ Position: _________________ Location: _______________________

HOW DID YOU HEAR ABOUT THIS OPPORTUNITY?

ο Monster ο Newspaper ο Leisureworld Website ο Job Fair ο HRDC ο Other ____________ ο


Employee Referral (List Name and Home of employee) __________________________

POSITION APPLYING FOR:

ο Registered Nurse (RN) ο Registered Practical Nurse (RPN) ο Personal Support Worker (PSW)
ο Other (please specify) __________________________________________________________________________

AVAILABILITY:

ο Days ο Evenings ο Nights ο Weekends ο Full Time ο Part Time


Date available to begin work? ________________________________________________________________

LOCATION INTERESTED IN:

ο Barrie ο Brantford ο Etobicoke ο Gravenhurst ο North Bay ο Richmond Hill ο Toronto GTA
ο Brampton ο Creemore ο Elmira ο North York ο Orillia ο Scarborough οVaughan
ο Oxford ο Streetsville ο Mississauga ο Altamont

1/16/09
Please complete this section if you are NOT attaching a resume.
EDUCATION: Documents of proof will be required upon offer of employment
Academic Institution Program Studied Diploma/Degree/License/Certificate Obtained
College
University
Other

EMPLOYMENT HISTORY: Begin with the most recent employer

Employment Date (mm/dd/yy): From: To: Status: ο Full Time ο Part Time
Employer: Position:

Address: Telephone:

Name and Title


Reason for Leaving:
of Supervisor:

Describe work and responsibilities:

Employment Date (mm/dd/yy): From: To: Status: ο Full Time ο Part Time
Employer: Position:

Address: Telephone:

Name and Title


Reason for Leaving:
of Supervisor:

Describe work and responsibilities:

Employment Date (mm/dd/yy): From: To: Status: ο Full Time ο Part Time
Employer: Position:

Address: Telephone:

Name and Title


Reason for Leaving:
of Supervisor:

Describe work and responsibilities:

I hereby declare that the foregoing information is true and complete. I understand that a false statement may disqualify me from employment,
or result in my termination for just cause. I understand further that any offer of employment made is subject to two (2) satisfactory references
and a satisfactory criminal reference check. Any reference information obtained will be kept confidential and not be released. I acknowledge
and agree that should the any reference check be deemed unsatisfactory, any offer of employment which may have been extended will be
withdrawn.

I acknowledge that an initial and/or annual medication examination may be required as a condition of my continued employment.

Applicant’s Signature: Date: ____________________________


1/16/09

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