Online Employment Application

• *Last name
• Middle Name
• *First Name
• Preferred Name

• Apartment #
• Street
• P.O. Box
• City/Town
• Province
• Postal Code

• *Home Phone
• Work Phone
• Messages
• *Email Address

• Full Time
• Part Time
• Term
• Casual

• Days
• Evenings
• Nights
• Weekends

• Beausejour Health Centre
• East-Gate Lodge, Beausejour
• Kin Place Health Complex, Oakbank
• Lac du Bonnet Personal Care Home
• Lac du Bonnet Health Centre
• Pinawa Hospital
• Corporate Office, Pinawa
• Pine Falls Health Complex
• Sunnywood Personal Care Home Pine Falls
• Whitemouth District Health Centre
• Home Care
• Mental Health
• Public Health
• Emergency Medical Services

• Grade Completed None 7 8 9 10 11 12 13
• Received Diploma Yes No

• Years Completed None 1 2 3 4 5 6
• Received Diploma, License; Degree or Certificate Yes No
• Describe Course of Study
• School Name and Location

• Years Completed None 1 2 3 4 5 6
• Received Diploma, License; Degree or Certificate Yes No
• Describe Course of Study
• School Name and Location

• Please describe any specialized training, apprenticeship training, other job skills: volunteer experience or hobbies that may apply to the job.
• Keyboarding wpm
• Computer Skills Yes No
• Word Processing Applications:
• Spreadsheet Applications:

• Company Name
• Type of Business
• Address
• Phone Number
• Name of Supervisor
• From Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
• To Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
• Final Salary
• Describe the work you did and the position(s) you held. Duties
• Reason for leaving
  

• Company Name
• Type of Business
• Address
• Phone Number
• Name of Supervisor
• From Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
• To Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
• Final Salary
• Describe the work you did and the position(s) you held. Duties
• Reason for leaving
  

• Company Name
• Type of Business
• Address
• Phone Number
• Name of Supervisor
• From Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
• To Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
• Final Salary
• Describe the work you did and the position(s) you held. Duties
• Reason for leaving
  

• Company Name
• Type of Business
• Address
• Phone Number
• Name of Supervisor
• From Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
• To Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
• Final Salary
• Describe the work you did and the position(s) you held. Duties
• Reason for leaving
  

• May we contact your current employer? Yes No
• Are you legally entitled to work in Canada? Yes No
• Have you ever been employed with the North Eastman Health Association Inc. or a North Eastman Facility or Service? Yes No
• If yes, in what Location and Department?
• How soon could you start work if hired?
• If hired, do you have a reliable means of transportation to get to work?

PLEASE READ CAREFULLY BEFORE SUBMITTING

The information I have reported on this application form and/or the attached resume is complete and accurate. I understand that giving incomplete, inaccurate or false information can lead to my dismissal at any time. If I am hired, I agree to perform all work and services assigned to me by the North Eastman Health Association diligently, honestly and faithfully. I agree to obey all the policies and procedures of the organization that relate to my employment. I am aware that if hired, I may be dismissed without notice, or pay in lieu of notice and without just cause during my probationary period.

Specific positions with the North Eastman Health Association are subject to a Criminal Records Check and if required, may also be subject to a Child Abuse Registry Check. Costs incurred are the responsibility of the applicant.

AUTHORIZATION TO COMMUNICATE PRIVATE INFORMATION:

I have applied for employment with the North Eastman Health Association. I hereby authorize any school, former employer, private person, or other organization to provide any information it has in relation to me to the North Eastman Health Association or its representatives.

In the event that I become an employee of the North Eastman Health Association, I authorize the North Eastman Health Association to divulge any personal information in relation to me to any other company, organization, or individual which I have authorized to investigate me.

• * I understand and agree to the above