Serenity Home Care Application Form

Application Form

Our values: Passion for transforming lives Compassionate, caring and loving Go above and beyond Strive for excellence

Personal Information

First Name *

Last Name *

Home Phone *

Work Phone

Mobile Phone

Email *

Address 1 *

Address 2

City *

Province

Postal Code *

Driver's License Number

Section 1 - General Information

Position(s) you are applying for?

Do you own a vehicle that you could transport a client in? (required)

Yes No

How did you hear about us? (required)

Did someone refer you to Serenity Home Care? If so, please enter their name

How long have you been in the healthcare field? (required)

Section 2 - Employment Eligibility

Are you eligible to work in Canada? (Proof of eligibility will be required before you can be employed.) (required)

Yes No

Section 4 - Other Training: Certifications/Licenses

Certifications/Licenses

Year of completion?

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Name of School you did your training (please provide location): (required)

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Section 11 - Availability

Start Date

Work Availability? (required)

Effective Date *

Section 12 - Skills

What other abilities or skills do you have that would help you do well in this role?

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By electronically submitting this application I certify that I the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentation of facts called for in my application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information.

Signature