Please fill out the form below and we will be in touch!
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
Upload Your Credential
Attach Certificate
Attach Resume
Attach Picture ID
Attach Police Background Check
Do you have SIN?
YesNo
Attach SIN Number (If Your have)
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.
