Employee Application Form Please fill out the form below or click the button to download an application. Application for Employment Position Applying ForPlease SelectPersonal Support WorkerRegistered Practical NurseHealth Care AideRegistered NurseLast or Family Name * Required First Name * Required Initials Email * Required Address * Required Street Address Address Line 2 City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code What is your Major Intersection? Home Telephone * RequiredCell PhoneDate of Birth * Required MM slash DD slash YYYY Are you legally entitled to obtain employment in Canada? Yes No Are you bondable? Yes No Have you ever been convicted of a crime for which a pardon has NOT been granted? Yes No Do you have a car? Yes No Communication Please check or name the languages you can communicate in the most fluently.English Read Write Speak French Read Write Speak Italian Read Write Speak Other Language Do you have a current certification in FIRST AID / CPR?Please SelectYesNoEducationName of Course Institution Length of Course Year Completed Finished ProgramPlease SelectYesNoOther Education Include courses/programs from other Provinces or Countries where applicable.Name of Course Institution Length of Course Year Completed Name of Course Institution Length of Course Year Completed EmploymentName of Employer Address Telephone NumberPosition Held Dates Employed Supervisor DutiesReason for leavingMay we contact this person for reference purposes?Please SelectYesNoRate of Pay Name of Employer Address Telephone NumberPosition Held Dates Employed Supervisor DutiesReason for leavingMay we contact this person for reference purposes?Please SelectYesNoRate of Pay Upload Your ResumeMax. file size: 100 MB.References No family members or friends please.Name of Reference Relationship Organization/Address Telephone NumberName of Reference Relationship Organization/Address Telephone NumberTerms and Conditions Please read carefully and type your name below.Full Name (hereinafter referred to as “YOU”, “YOUR”, “I”, “ME” or “MY”) are an employee of Everest Nursing and Community Care Agency Inc. (hereinafter referred to as “EVEREST”) and will be sent to Home and Health Institutions to work (hereinafter referred to as “FACILITIES” or “FACILITY”). YOUR relationship with EVEREST is entered into as an elect to work arrangement and YOU have the right to decline work without penalty. YOU acknowledge that YOU will not receive termination pay. YOUR working hours will be recorded on an EVEREST time sheet. YOUR time sheet must be signed by an authorized representative at the FACILITY where YOUR shift was completed. The time sheet is YOUR responsibility and must be completed and forwarded to EVEREST at the end of each week. If YOU cannot do so, YOU must contact EVEREST no later than the following Monday morning. This will prevent waiting an extra pay period for YOUR pay. Pay periods are biweekly on Friday. Should any FACILITY that YOU have worked with offers YOU a position, YOU can only accept that position after YOU have worked with EVEREST for a minimum period of three (3) months, unless otherwise agreed upon between YOU and EVEREST. If YOU feel that any assignment at a FACILITY that YOU have been asked to perform is not safe, YOU should report this matter immediately to YOUR onsite supervisor and also immediately notify EVEREST in writing. No alcohol or drugs will be tolerated before or while YOU are at a FACILITY. In case of a personal injury at a FACILITY, YOU must fill out an incident report at the FACILITY and also notify EVEREST in writing within twenty-four (24) hours of the incident. All notices to EVEREST must be sent to: Everest Nursing & Community Care Agency Inc. 2145 Dunwin Drive, Unit 3, Mississauga, ON - L5L 4L9 I hereby certify that the facts and statements made by me on this application are true and correct to the best of my knowledge, information and belief. This information may be used to obtain a Fidelity Bond. I certify that I have read and understood the Terms and Conditions of this agreement and realize that failure to comply may result in the termination of my employment with EVEREST. I understand that, if employed, false statements on this application shall be considered sufficient cause for legal action.Signature * Required Date * Required MM slash DD slash YYYY CAPTCHA Contact Everest Home Health Care Today Call Now
