Employment application form

* Required fields

Surname *		First Name *
Mailing address *				City *
Prov / State *	Code / Zip *	Email *
Telephone Number (Home) *		Telephone Number (Other)
Category of employment desired *
Infirmière-chef – Head Nurse Infirmières – RN Infirmières auxiliaires – LPN Activités – Activities Ouvrier agricole – Farm hand Entretien ménager – Housekeeper		Services alimentaires – Food Services Cuisinier – Cook Maintenance du bâtiment – Maintenance Ergothérapeute – Occupational therapist Buanderie – Laundry		Préposés aux bénéficiaires – Caregivers Assistant administratif – Administrative assistant Acheteur – Purchasing Autres - Others - Specify :
Type of employment *
Permanent Temporary Student		Full time Part time (on call)
Availability date *

Education
	Institution	Specialisation	Last year completed or diploma received
Secondary:
College:
University:
Other:

Do you have any incapacities which prohibit you from doing certain types of work? *
Yes	No
If so, please specify the type of work or movements which are prohibited:
Have you ever been convicted for a civil or criminal act in relation to your work? *
Yes	No
If so, specify:
Have you ever been dismissed or asked to resign from a job? *
Yes	No
If so, specify:
Do you have permit (licence) or card of competency? *
Yes	No
Which one?		# of certificate:	Date received:
Have you worked for The Wales Home before? *
Yes	No
If so, which job?		If so, when and for how long?
Why do you want to work for The Wales Home? *

Employment history
Employer’s Name
Employer’s Telephone Number	Employer’s Address
Occupation and functions completed
Salary	Start Date	End Date
Reason for leaving

Employer’s Name
Employer’s Telephone Number	Employer’s Address
Occupation and functions completed
Salary	Start Date	End Date
Reason for leaving

Employer’s Name
Employer’s Telephone Number	Employer’s Address
Occupation and functions completed
Salary	Start Date	End Date
Reason for leaving

Upload your CV * : (pdf, doc or docx)

I declare that the information provided above is to my knowledge complete and true. I understand that a false declaration on my part could result in the rejection of my candidacy or immediate termination of my employment.

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