Seniors Links Program Students' Online Application Form
Thank you for your interest in working with seniors.  Please complete this form and a staff will contact you for a brief phone interview to screen eligibility.
For any questions or concerns about this form, please call Eric (Mon and Tue only): 604-324-6212 or email at: eric@southvan.org
This program is funded by the Vancouver Coastal Health Smart Fund.   This is a service provided by South Vancouver Neighbourhood House.
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Last Name *
Your family name
First Name *
Your first name
Are you a male or female? *
Most female seniors living alone prefer to work with female students
Address *
Your house / apartment number and street name
City you live in *
Vancouver / Burnaby / New Westminster / Coquitlam
Postal Code *
Eg V5P 3X7
Your Primary Phone Number *
Your Secondary Phone Number
Your Email Address *
Are you a Canadian Citizen or Permanent Resident in Canada? *
If your answer is "No" in the last question, do you have a valid work permit?
Indicate if you are legally entitled to work in Canada.
Current Langara College Program Enrolled In *
If you are not a Langara College Student, answer "N / A"
Are you a Full Time or Part Time student? *
Langara College Student ID Number
Enter your 9-digit student number here; leave it blank if you are not a student
Do you have experience working with seniors? *
If your answer is "Yes" in the last question, please briefly describe these experiences *
Point form please and  limit your input to 50 words. Put "N / A" if you have no experience
Do you have a current criminal record check document? *
A criminal record check is a definite asset, but is not required at this time
Please check any skills or types of job(s) that you would like to do for seniors *
Please check at least one
Required
Please mark your shift availability *
Indicate when you are free to serve; if you are free any week day or weekend, check the latter boxes
Required
Please indicate any languages, other than English, in which you are fluent *
Training certificates / licences you hold
First aid, food safe, etc.
The availability you have indicated is valid until... *
Eg Summer, until the end of August, 2012, etc.
How long are you able to commit to this program? *
Eg Summer, until the end of August, 2012, etc.
Other information you feel would be useful
Point form please and limit your input to 50 words
Submit
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