Application for Employment Which of the following programs are you interested in working in? Adult Day Centre Better at Home Residential Support Worker Office Transportation Vermilion Court Support Worker Maintenance Are you legally able to work in Canada? YesNo Did you complete Grade 12? YesNo Do you have a valid BC Driver’s License? YesNo Do you have your own transportation? YesNo Do you have valid car insurance (027/007)? YesNo Do you have a current First Aid certificate? YesNo Do you have a current Food Safe certificate? YesNo Are you registered as a BC Care Aide and Community Health Worker? YesNo Our agency has programs which operate 7 days per week. We require employees to be available as needed and scheduling is done accordingly. Are you able to work as needed? YesNo REFERENCES Please provide 3 references, preferably employers, but you may use one personal reference. Please list employers, most recent first. 1.Employer Name & Address Supervisor’s Name and telephone no. Employed from to Position/Duties Reason for Leaving May we contact this employer? YesNo 2.Employer Name & Address Supervisor’s Name and telephone no. Employed from to Position/Duties Reason for Leaving May we contact this employer? YesNo 3.Employer Name & Address Supervisor’s Name and telephone no. Employed from to Position/Duties Reason for Leaving May we contact this employer? YesNo Personal Reference Following a successful interview and prior to commencing employment, applicants must submit a Criminal Record Search, medical form, TB skin test certification, driver’s abstract, driver’s license and proof of vehicle insurance. Criminal record search is done internally. This application is considered a legal document and any false information will forfeit any claims to employment. By signing this form you acknowledge that Princeton & District Community Services Society has the right to check the validity of this application.
