Clarion Nursing Home and
Lakeview Retirement Centre

337 Highway 8, Stoney Creek, ON L8G 1E7 ~ Phone 905-664-2281

APPLICATION FOR EMPLOYMENT

Date

 
Name  
Are you submitting to Clarion NH Lakeview RC Both  
Address  
City  
Province  
Postal Code  
Phone Number
Home
           Work
Email Address  

Are you legally entitled to work in Canada?

YES NO
You are interested in working   FT PT Either
Position applied for    
How many days per week can you work?                          
Date available    
 

EDUCATION

Highest grade or level complete  
Certificate or diploma achieved  

Other interests & hobbies

 
 

EMPLOYMENT HISTORY

Recent Employers
(most recent first)

Start and End Dates

Phone Number and Position

1 to

2 to
3 to
4 to

 

Are you willing to work all shifts?

YES NO
Are you willing to come in on short notice? YES NO
Are you willing to work in areas other than the one you may be hired for? YES NO

Have you any previous Nursing Home experience?

YES NO
  If so, where?
Were you sent by an agency?
YES NO

If so, which agency?

By clicking the Submit button you agree to the statement below.

I hereby declare that I have read and understood the questions on this application, and that all information provided by me is true and complete to the best of my knowledge, and I understand that a false statement may disqualify me from securing employment, or may cause my dismissal.

Date