Franchise 3034 Application Form
Application Form
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age sex, religion, disability, medical condition, national origin, or marital status.
Office Location
Select Office Location
-- Select Office --
Barrie
Bradford
Gravenhurst
Orillia
Personal Information
First Name
*
Last Name
*
Home Phone
*
Work Phone
Mobile Phone
Email
*
Address 1
*
Address 2
City
*
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisana
Maine
Maryland
Massachusetts
Michigan
Military Personnel - America
Military Personnel - Europe
Military Personnel - Pacific
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
U.S. Minor Outlying Islands
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code
*
Driver's License Number
--
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
AA
AE
AP
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UM
UT
VT
VI
VA
WA
WV
WI
WY
Section 1 -
General Information
Position Applying For:
(required)
How did you hear about us?
(required)
-- Select an Option --
Job Ad/Job Board
Comfort Keepers' Website
Employment Agency
Current CK Employee
Other
Preferred Method of Contact?
(required)
-- Select an Option --
Home Phone
Cell Phone
Email
No Preference
When is the best time to contact you?
(required)
-- Select an Option --
Mornings
Afternoons
Evenings
Weekends
Anytime
Do you speak a language other than English?
(required)
Yes
No
What other language(s) do you speak?
Section 2 -
Educational Background
Do you have a High School Diploma or GED?
(required)
Yes
No
Do you have a College Diploma or University Degree?
(required)
Yes
No
Do you hold a valid Canadian PSW/HCA (or equivalent) qualification?
(required)
Yes
No
From which school/institution?
Please list other relevant courses or training completed:
Are you currently certified in both CPR and First Aid?
(required)
Yes
No
Please list specific medical conditions/diseases that you either have experience with, or have received special training/certification for. Please provide as much detail as possible.
Section 3 -
Employment Information
What date are you available for Employment?
(required)
Are you able to work overtime, if required?
(required)
Yes
No
Are there any periods of time that you absolutely CANNOT work?
(required)
Yes
No
When are you unavailable to work?
-- Select an Option --
Mornings
Afternoons
Evenings
Overnight
Weekends
Are you able to meet the attendance requirements of the position?
(required)
Yes
No
Do you have reliable transportation to and from work, and for travel between work sites? Use of municipal/regional transit is considered reliable transportation.
(required)
Yes
No
Have you previously applied for a position at Comfort Keepers?
(required)
Yes
No
Have you previously worked at Comfort Keepers?
Yes
No
Do you have any relatives currently employed by Comfort Keepers?
(required)
Yes
No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodations?
(required)
Yes
No
If no, describe the functions that cannot be performed:
Are you eligible to work in Canada? (Proof of eligibility will be required before you can be employed.)
(required)
Yes
No
Have you ever been convicted of/or plead guilty to a crime (other than minor traffic violations)?
(required)
Yes
No
If yes, please explain: (give date, location, charge, etc.) Please note that in order to be hired by Comfort Keepers, you will be required to undergo a Vulnerable Sector Police Check with your local police department.
If the job requires, do you have a valid drivers license?
(required)
Yes
No
Have you had any moving violations in the past 3 Years?
(required)
Yes
No
Section 4 -
Most Recent Employer
Employer
Address
City, Province, Postal Code
Start Date
End Date
Position/Title:
Summarize the nature of the work performed and job responsibilities
Show Plain Text
Supervisor's Name and Title
Supervisor's Phone Number
(Numeric Answer Only)
Reason(s) for Leaving:
Section 5 -
Second Most Recent Employer
Employer
Address
City, Province, Postal Code
Start Date
End Date
Position/Title:
Summarize the nature of the work performed and job responsibilities
Show Plain Text
Supervisor's Name and Title
Supervisor's Phone Number
(Numeric Answer Only)
Reason(s) for Leaving:
Section 6 -
Third Most Recent Employer
Employer
Address
City, Province, Postal Code
Start Date
End Date
Position/Title:
Summarize the nature of the work performed and job responsibilities
Show Plain Text
Supervisor's Name and Title
Supervisor's Phone Number
(Numeric Answer Only)
Reason(s) for Leaving:
Section 7 -
Resume
Please use this space to cut and past your resume, or a portion thereof. Submission of a resume is not an alternative to completing this application. Only complete applications will be considered.
Show Plain Text
Section 8 -
Reference 1
Name:
Telephone Number:
(Numeric Answer Only)
Years Known:
(Numeric Answer Only)
Relationship:
Section 9 -
Reference 2
Name:
Telephone Number:
(Numeric Answer Only)
Years Known:
(Numeric Answer Only)
Relationship:
Section 10 -
Applicants Certification and Agreement
I certify that the facts contained in this application and/or interview(s) are true and complete. Any misrepresentation or falsification of information or significant omissions will be cause for rejection of my application or for subsequent discipline up to and including my dismissal from employment if discovered at a later date.
(required)
Yes
No
I understand that, if employed, my employment is not guaranteed for any term, and my employment may be terminated by the employer or myself at any time and for any reason with or without prior notice.
(required)
Yes
No
If I am employed, I agree to comply with and be bound by the safety and health rules and regulations, and rules of conduct of Comfort Keepers.
(required)
Yes
No
This application will remain on active file for 60 days. If I am hired within this period, this form will be transferred to my individual personnel file. If I am not hired or have not heard from this employer within 60 days, this application is no longer active and I will need to reapply for employment if I wish to be considered for a job with Comfort Keepers.
(required)
Yes
No
I give the employer and /or its agents, including consumer reporting bureaus, the right to investigate any and all statements made in this application for the purpose of employment and retention of employment.
(required)
Yes
No
If required, I agree to a drug testing prior and during employment or for post incident investigations.
(required)
Yes
No
The employer, Comfort Keepers, is an Equal Opportunity Employer. The employer does not discriminate in employment and no questions on this application is used for the purpose of limiting or excusing any applicants consideration for employment on a basis prohibited by local, provincial, or federal law.
(required)
Yes
No
I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.
Signature
Submit Application