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EMPLOYMENT APPLICATION IMPORTANT: PLEASE READ THE FOLLOWING:
1. This employment application form is to be used by external applicants.
2. We thank all applicants for their interest, however, only those selected for an interview will be contacted.
3. Incomplete applications may not be considered.
4. Submit completed applications using one of the following two methods:
| FAX TO:
(403) 220-1128 |
|
MAIL TO:
| Southwood Care Centre | | 211 Heritage Drive SE | | Calgary, Alberta T2H 1M9 |
|
POSITION INFORMATION (PLEASE PRINT) |
POSITION:
|
LOCATION: |
DESIRED: |
|
q |
CHINOOK |
q |
FULL TIME |
| |
q |
BRENTWOOD |
q |
PART TIME |
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q |
SOUTHWOOD |
q |
CASUAL |
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DATE AVAILABLE: _______________ SHIFT AVAILABLE
q DAYS
q
EVENINGS
q NIGHTS
q WEEKENDS
|
PERSONAL INFORMATION | LAST NAME | FIRST NAME AND INITIAL | HOME ADDRESS | CITY | PROVINCE | POSTAL CODE | ARE YOU LEGALLY ELIGIBLE TO WORK IN CANADA? | TELEPHONE (HOME) | TELEPHONE (WORK) |
GENERAL INFORMATION | HAVE YOU EVER BEEN EMPLOYED BY INTERCARE?
q Yes
q No | IF YES, INDICATE LOCATION | POSITION HELD | DO YOU HAVE ANY RELATIVES EMPLOYED BY INTERCARE?
q Yes
q No | IF YES, PLEASE INDICATE LOCATION AND POSITION HELD | HOW DID YOU FIND OUT ABOUT THIS POSITION?
q NEWSPAPER AD
q CAREER FAIR
q EMPLOYEE
q OTHER ________________________ |
|
EDUCATION AND
TRAINING
SCHOOLING:
HIGHEST GRADE ACHIEVED: ____YR. COMPLETED ____ NAME OF SCHOOL
ATTENDED _____________
POST-SECONDARY EDUCATION:
0 UNIVERSITY 0 COLLEGE 0 TECHNICAL SCHOOL 0 OTHER
__________________(PLEASE SPECIFY)
NAME AND LOCATION OF INSTITUTE:
__________________________________________________________
COURSE OF STUDY OR MAJOR ________________________DIPLOMA/DEGREE
OBTAINED
YES
q
NO
IF YES, PLEASE STATE DATE OF COMPLETION
__________________________________________________
ADDITIONAL RELATED EDUCATION:
____________________________________________________________
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EMPLOYMENT HISTORY
MOST
RECENT |
POSITION/TITLE |
EMPLOYER'S
ADDRESS |
SUPERVISOR'S
NAME, POSITION, PHONE NUMBER
|
|
DATE STARTED |
DATE LEFT |
AVERAGE WEEKLY
HOURS |
REASON FOR LEAVING
|
FUNCTIONS/RESPONSIBILITIES
|
2nd TO
LAST |
POSITION/TITLE |
EMPLOYER'S
ADDRESS |
SUPERVISOR'S
NAME, POSITION, PHONE NUMBER
|
|
DATE STARTED |
DATE LEFT |
AVERAGE WEEKLY
HOURS |
REASON FOR LEAVING
|
FUNCTIONS/RESPONSIBILITIES
|
3rd
TO
LAST |
POSITION/TITLE |
EMPLOYER'S
ADDRESS |
SUPERVISOR'S
NAME, POSITION, PHONE NUMBER
|
|
DATE STARTED |
DATE LEFT |
AVERAGE WEEKLY
HOURS |
REASON FOR LEAVING
|
FUNCTIONS/RESPONSIBILITIES
|
|
REFERENCES
FOR EMPLOYMENT REFERENCES,
MAY WE APPROACH:
YOUR PRESENT/LAST EMPLOYER?
q
YES
q
NO
YOUR FORMER EMPLOYER(S)?
q
YES
q
NO
LIST ANY ADDITIONAL REFERENCES (RELATED TO WORK)
____________________________________________________________________________________________
____________________________________________________________________________________________
APPLICANT'S DECLARATION
Before signing please be sure
your application is filled out completely and that you have
read and understood the following:
-
I declare the statements
made by me in this application are, to the best of my
knowledge. I realize that any false statement
deliberately made will be grounds for dismissal. I also
understand that, if hired I must successfully complete a
probationary period.
-
With my agreement,
Intercare Corporate Group may contact my present and
former employers as identified to obtain references.
-
Obtaining a security
clearance, i.e. A satisfactory criminal record check is
a condition of employment. I understand it is my
responsibility to pay all costs related to obtaining a
criminal record check.
-
I understand that the
pass/fail results of the criminal check will be kept in
confidence in the Human Resources Department, and will
only be disclosed to the Hiring Manager.
-
To protect the health of
our residents and staff, all new employees are required
to have an annual flu immunization (available at the
care center).
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APPLICANT'S SIGNATURE |
|
DATE |
Please be advised that the personal information you have provided herein may be used for the purpose of employment only, and conforms to Section 32 of the Freedom of Information and Protection of Privacy Act. For additional information, contact our Human Resource Department. Have you attached a resume of additional information? q YES q NO
This information is collected pursuant to
the Intercare Corporate Group Inc. Privacy Policy. The
company is collecting and using this personal employee
information for the establishment, management and
termination of your employment relationship, as well as for
payroll, benefits administration (including sickness,
disability, and pension benefits as applicable) and other
reasonable purposes regarding your employment.
#03-05-06/2003
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