Franchise 4009 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 --
Cache-Ashcroft
Kamloops
Personal Information
First Name
*
Last Name
*
Home Phone
*
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Mobile Phone
Email
*
Address 1
*
Address 2
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*
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*
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--
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Section 1 -
General Information
Position(s) Applying For:
(required)
How did you hear about Comfort Keepers?
(required)
-- Select an Option --
Website or other Advertisement
Current Comfort Keepers Employee
Relative
Employment Agency
Other
Preferred method of contact?
When is the best time to call you?
(required)
Languages spoken other than English?
Were you referred by a current Comfort Keepers employee?
Yes
No
If yes, please provide the employee's name
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 (or equivalent) qualification?
(required)
Yes
No
From which school?
(required)
Please list other relevant courses/certificates completed:
(required)
Are you currently certified in 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. Give as much detail as possible.
Show Plain Text
Section 3 -
Employment Information
What date are you available for Employment?
(required)
Type of employment desired (Type All that Apply) Full Time, Part Time, Temporary, Seasonal.
(required)
Are you able to work overtime, if required?
(required)
Yes
No
Are you able to meet the attendance requirements of the position?
(required)
Yes
No
Have you previously applied for a position at Comfort Keepers?
(required)
Yes
No
If Yes, then when?
Have you previously worked at Comfort Keepers?
Yes
No
Enter date last worked.
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 must be Bondable.)
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
If yes, please describe:
Do you have any relatives currently employed by Comfort Keepers?
(required)
Yes
No
If yes, please list:
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: (Note: we comply with the ADA and consider reasonable accommodations measure that may be necessary to eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)
Section 4 -
Most Recent Employer
Employer
(required)
Start Date
(required)
End Date
(required)
Address
(required)
City, Province, Postal Code
(required)
Phone Number
(required)
(Numeric Answer Only)
Starting Rate
(Numeric Answer Only)
Ending Rate
(Numeric Answer Only)
Position/Title:
(required)
Summarize the nature of the work performed and job responsibilities:
(required)
Show Plain Text
Name of Supervisor
(required)
Supervisor's Phone Number
(required)
May we contact?
Yes
No
Reason(s) for Leaving:
(required)
Section 5 -
Second Most Recent Employer
Employer
(required)
Start Date
(required)
End Date
(required)
Address
(required)
City, Province, Postal Code
(required)
Phone Number
(required)
(Numeric Answer Only)
Starting Salary
(Numeric Answer Only)
Ending Salary
(Numeric Answer Only)
Job Title
Name of Supervisor
Reason(s) for Leaving:
Summarize the nature of the work performed and job responsibilities
(required)
Show Plain Text
Section 6 -
Third Most Recent Employer
Employer
(required)
Start Date
(required)
End Date
(required)
Address
(required)
City, Province, Postal Code
(required)
Phone Number
(required)
(Numeric Answer Only)
Starting Salary
(Numeric Answer Only)
Ending Salary
(Numeric Answer Only)
Job Title
(required)
Name of Supervisor
(required)
Reason(s) for Leaving:
Summarize the nature of the work performed and job responsibilities
(required)
Show Plain Text
Section 7 -
Other Employers and Comments
Comments and other Skills, licenses/certification and qualifications (including explanation of any gaps in employment)
Show Plain Text
Section 8 -
Resume
Please use this space to copy and paste your resume, or a portion thereof. Submission of a resume, in whole or in part, is not an alternative to completing this application. Only complete applications will be considered.
Show Plain Text
Section 9 -
Professional References
Reference 1 - Name:
(required)
Telephone Number
(required)
(Numeric Answer Only)
Years Known
(Numeric Answer Only)
Relationship
Reference 2 - Name:
(required)
Telephone Number
(required)
(Numeric Answer Only)
Years Known
(Numeric Answer Only)
Relationship
Reference 3 - Name:
(required)
Telephone Number
(required)
(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. No representative of Comfort Keepers other than the owner(s) is authorized to make any assurance or promise of continued employment and any such assurance must be in writing signed by the owner(s).
(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. This investigation may include, but not limited to, credit reports, criminal conviction records, motor vehicle driving records and previous employment history. Further, I hereby release from liability and hold harmless this employer, its representatives, all persons and organizations/companies for furnishing such information.
(required)
Yes
No
If required, I agree to a drug testing prior and during employment or for post accident occurrences.
(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