Integrity Home Health Services - Integrity is Everything

JOB APPLICATION

Fill out the form below if interested in working with Integrity

Printable Version

Fields in bold are required.

Position Applied For:
What office are you applying for:
Date
Name
Insert Resume File
Phone Number
Address
Address
City
Province
Postal Code
Positions Available	Home Support Worker Personal Care/Attendant Care Companion Sitter Human Services Counselor LPN RN Other
Days/Hours available to Work?
Monday - Hours:
Tuesday - Hours:
Wednesday - Hours:
Thursday - Hours:
Friday - Hours:
Saturday - Hours:
Sunday - Hours:
Employment Desired:
Option:
School Degree Acquired
Type of school:
Name of School:
Location:
Number of Years Completed:
Specifics
Have you ever been convicted of a crime which is substantially related to the functions or qualifications of the job for which you are applying?	Yes No
(a conviction record will not necessarily disqualify you from employment).
Do You Have Driver's Licence?	Yes No
Do You Have Transportation?	Yes No
Please list two references other than relatives.
Name
Position
Company
Address
Telephone
Name
Position
Company
Address
Telephone
Please use this space to elaborate on any background, experience or qualifications that you believe should be considered in evaluating your qualifications for employment.
You may include hobbies, volunteer experience and any other activities you believe relevant. Please omit any information that would disclose your race, gender, age, marital status, ethnic origin, religious or political affiliations, or disability.
Please list your work experience in the past two years beginning with your most recent job held. If you were self-employed, give firm name.
Name of Employer
Address
City
Province
Postal Code
Phone Number
Name of last Supervisor
Start of Employment
End of Employment
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of Employer
Address
City
Province
Postal Code
Phone Number
Name of last Supervisor
Start of Employment
End of Employment
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of Employer
Address
City
Province
Postal Code
Phone Number
Name of last Supervisor
Start of Employment
End of Employment
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of Employer
Address
City
Province
Postal Code
Phone Number
Name of last Supervisor
Start of Employment
End of Employment
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
May we contact your present employer?	Yes No
Did you complete this application yourself?	Yes No
If not, who did?
After reviewing the attached job description, please indicate if you are able to perform the essential functions of the job for which you have applied.	Yes No
If you answered"NO", please identify those job functions that you cannot perform. If a reasonable accommodation is required to enable you to perform the job properly and safely, please describe below.
APPLICATION FORM WAIVER
As indication that you have read and understood each sentence, please write your initials in the following spaces
I authorize of all statements contained in this application.
I understand that the misrepresentation or omission of facts called for dismissal at any time without any previous notice.
I herby give INTEGRITY HOME HEALTH SERVICES permission to contact schools, all previous employers unless otherwise stated), and references and herby release the Company from any liability as a result of such contact.
SIGNATURE OF APPLICANT
(By typing in your name and sending the application form it is as compatible as a signature.)
Day the form was completed: