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    Last Name*



    First Name*



    Middle Name



    Address*



    Phone*



    City



    Province*



    Postal Code



    Primary Email*




    High School Completed Grade 12:

    YesNo


    Position Applied For*

    Recreation TherapistFriend at Home (Companion)Personal Support at Home (PSW)RPN/RN (Nurse)Registered Practical Nurse (RPN) - Foot Care

    Other


    Biography*



    Languages Spoken*:

    EnglishItalianFrenchGermanSerbianCroatianUkranianPolishSlovenianSpanishPortuguesePanjabi (Punjabi)Tagalog (Pilipino, Filipino)UrduArabicTamilPersian(Farsi)Chinese Languages(Please Specify)


    Other





    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


    If Yes, please specify



    Do You Have a CPR / First Aid Certificate ?

    YesNo


    Do You Have a Drivers Licence?

    YesNo


    Do You Have Acces to a Car?

    YesNo


    Do You Have Acces to Public Transit?

    YesNo


    What Areas are You Available to Work*?

    BurlingtonOakvilleMiltonGeorgetownMississaugaTorontoScarboroughRichmond HillMarkhamPickeringWhitbyAjaxOshawa

    Other



    What Days are You Available for Work*?



    What Time(s) of Day are you Available for Work*?

    MorningAfternoonEveningOvernight



    Add any Additional Time(s) of Day Availability Comments:




    Smoker*?

    YesNo

    Allergies?

    YesNo

    If yes please list




    Attachments*:



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    (allowed file types: pdf, doc, docx,xls, xlsx)


    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 iCare Home Health. I also consent to this information being used for identification and payroll purposes should iCare Home Health 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.

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