Respite Worker Application

• First Name:
• Last Name:
• Address:
• Apt/Unit:
• City:
• Province:
• Postal Code:
• Email:
• Telephone:
• Mobile:
• Are you legally eligible to work in Canada? Yes:   No:
• What languages do you speak fluently? English:   French:   Other (Please Specify):  
• Do you have access to a reliable vehicle for the purposes of work? Yes:   No:

Education

• High School: Institution and Program
  Diploma/Degree Received
• College: Institution and Program
  Diploma/Degree Received
• University: Institution and Program
  Diploma/Degree Received

Training

• Do you have a current CPR and First Aid Certificate? Yes:   No:
• If no, are you willing to obtain one? Yes:   No:
• Do you have current Non-violent Crisis Intervention certification? Yes:   No:
• Please list any other training/certifications:

Work Experience

• Company:
• Job Title:
• Duties:
• Employment Dates:
• Reason for Leaving:

•  

• Company:
• Job Title:
• Duties:
• Employment Dates:
• Reason for Leaving:

•  

• Company:
• Job Title:
• Duties:
• Employment Dates:
• Reason for Leaving:

•  

• Please list any volunteer experience:
• Please list any other relevant skills or life experiences not listed above:
• Please indicate which population you would prefer to work with (check all that apply): Children:   Adults:   Seniors:   No Preference:

Availability

• Please indicate your general availability for work.

  	Mon	Tue	Wed	Thu	Fri	Sat	Sun
  Morning
  Afternoon
  Evening
  Overnight

   

  How did you hear about Wesway?

Documents

• Please attach a resume and cover letter Document 1:
  Document 2:
  Document 3:

Statement Of Understanding

The information I have provided on this form is true and complete to the best of my knowledge. I understand that a false statement may disqualify me from employment. I am aware that personal information on this form is collected under the authority of the Personal Information Protection and Electronics Documents Act and will be used to determine eligibility for employment. This application will be destroyed in one year unless renewed. Questions concerning this collection should be directed to the Manager of Human Resources.

I have read and agree to the above.