A Friend Indeed: Job Application
The information on this form is collected for the purposes of evaluating your application for employment with our company and should you be offered employment, the application will help us match your skills to appropriate clients. All information collected by A Friend Indeed is protected by the Personal Information Protection and Electronic Documents Act and will be kept confidential. All of the questions below are optional and your consent is implied by submitting answers to the questions. Thank you.
Your Name (First and Last) *
Your answer
Your Address *
Your answer
Your Telephone Number(s) *
Your answer
Your Email *
Your answer
Your Birth Date *
Your answer
Allergies? *
Your answer
Languages Spoken? *
Your answer
How did you hear about A Friend Indeed? *
Your answer
Do you have a valid Drivers License? *
Anything else you would like to add?
Your answer
Do you have your own vehicle? *
What year, make and model is your vehicle? Would a senior be able to easily get into and out of it on their own? *
Your answer
Are you comfortable driving a client in your vehicle? *
What have you done that you are most proud of? *
Your answer
Are you willing to work in a smoking environment? *
Availability for work. Please select all of the days and times you are available for work on a consistent basis.
Mondays *
Required
Tuesday *
Required
Wednesday *
Required
Thursday *
Required
Friday *
Required
Saturday *
Required
Sunday *
Required
Is there any additional information you want to share about your availability?
Your answer
Areas you will work in. The more areas you are available to work in the easier it is to find work. *
Required
Anything else you would like to share about the locations to work in?
Your answer
Are you working right now? *
Your answer
Have you ever taken a care aid program? *
Your answer
Is your CPR up to date? *
Do you have any other health related courses or education? *
Your answer
What experience do you have with seniors? *
Your answer
Work Experience
1. Name of your most recent employer: *
Your answer
Date started:
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YYYY
Date completed:
MM
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DD
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YYYY
Reason for leaving:
Your answer
Duties:
Your answer
Contact name and phone number:
Your answer
May we contact your employer? *
2. Name of your previous employer:
Your answer
Date started:
MM
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DD
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YYYY
Date finished:
MM
/
DD
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YYYY
Reason for leaving:
Your answer
Duties:
Your answer
Contact Name and Phone:
Your answer
May we contact your employer? *
Please select activities you have experience with and are comfortable performing: *
Required
References: List 3 work related references that we may contact as a reference for you. (Excluding family and close friends)
1. Reference (Include: Name, Phone, Position/Company) *
Your answer
2. Reference (Include: Name, Phone, Position/Company) *
Your answer
3. Reference (Include: Name, Phone, Position/Company)
Your answer
Have you had a criminal record search done within the last year? *
Have you ever been arrested? *
Will you consent to having a police record check (with vulnerable sector) before being employed with us? *
I understand that failing to provide accurate information or omission of facts on this form may disqualify me from consideration for employment with A Friend Indeed or subsequent termination if I am employed. Submission of this application form implies your consent to contact you.
Your answer
Your Name: *
Your answer
Today's Date: *
MM
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