Clarion Nursing Home Application Form

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