First Name

Middle Name

Last Name

Your email

Phone Number

Residential Address

City

Province

Postal Code

List of Current Certifications

Tell us About Your Current Certifications

High School Completed Grade 12 YesNo

Position Applied For: Registered Nurses (RN)Personal Support Worker (PSW)Registered Psychiatric Nurse (RPN)Home Support Worker (HSW)Developmental Services Worker (DSW)

Other Position

Have you ever been convicted of a criminal offence for which a pardon has not been granted? YesNo

Are you currently working? YesNo

Are you comfortable working in a COVID positive facility? YesNo

Last Employer (Optional)

Bio

Languages Spoken (Select all as applicable) EnglishFrenchItalianGermanSerbianCroatianUkranianPolishSlovenianSpanishPortugueseArabicPanjabi (Punjabi)Tagalog (Pilipino, Filipino)UrduTamilPersian (Farsi)ChineseJapaneseKorean

Other Languages (Please Specify)

Do you have CPR First Aid Certificate? YesNo

Do you have General persuasion Approach (GPA) certificate? YesNo

Did you work with individuals dealing with epilepsy? YesNo

Do you have experience working with autistic children? YesNo

Do you have a valid police background check (within the last 12 months)? YesNo

Do you have a reliable vehicle? YesNo

Do You Have a PSW Certificate? YesNo

Do You Have Dementia Training and/or Experience? YesNo

Do You Have a Drivers License? YesNo

Do You Have Access to a Car? YesNo

Do You Have Access to Public Transit? YesNo

What Areas are You Available to Work? BurlingtonOakvilleMiltonGeorgetownMississaugaTorontoScarboroughRichmond HillMarkhamPickeringWhitbyAjaxOshawa
If Other Area (Specify | Optional)

What Days are You Available for Work? MondayTuesdayWednesdayThursdayFridaySaturdaySunday

What Time(s) of Day are you Available for Work? MorningAfternoonEveningOvernight
Add any Additional Time(s) of Day Availability Comments:

Do you smoke? YesNo

Do you have any Allergies? YesNo

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Attach Police Background Check


Do you have SIN?
YesNo

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Attach Vaccination Proof


The facts set forth in my application for employment are true and complete. I understand that if employed, false statements on the application shall be considered sufficient cause for legal action as well as immediate dismissal without notice and without payment in lieu of notice.
I consent to the information collected here being used to determine my eligibility and appropriateness for employment with DiPromise Health Care.
I also consent to this information being used for identification and payroll purposes should DiPromise Health Care later employ me.
I understand that I am responsible for my own transportation.



By submitting my Application online, I attest that I have read and understand the information contained above.