Application For Employment

» downloadable Application for Employment form « 

Personal Data (please print)

Last name

First name

middle

Address

City

Province

Postal Code

Home Phone

Work Phone

email


POSITION

Position Applied for

Competition Number

Date of Availability


Background

Education Level:High School

School Name

Highest Grade, Diploma or Degree Awarded

Year completed

Education Level:Post Secondary Education (College/Technical Training)

School Name

Highest Grade, Diploma or Degree Awarded

Year completed

Education Level:University

School Name

Highest Grade, Diploma or Degree Awarded

Year completed

Education Level:Other Related Education/Training

School Name

Highest Grade, Diploma or Degree Awarded

Year completed


Are you currently registered with a Professional Association? (if “yes,” please complete this section)
 No Yes

Association

Certificate Number

Province


Do you have a current Alberta Driver’s License?  No Yes

Are you fluent with the English Language:  No Yes

Are you fluent in other languages?  No Yes

If “yes,” please list:


Have you ever been employed with a Health Care Facility or Community Health Program within the Health Region?
 No Yes

Please list site(s):


Are you available to work:

Shift Work  No Yes

Weekends  No Yes

Statutory Holidays  No Yes


Please indicate the type of employment desired
 Full Time Part Time Casual Temp


Comments:


PREVIOUS EMPLOYMENT (please start with most recent)

COMPANY NAME

ADDRESS OF EMPLOYER

TELEPHONE

YOUR SUPERVISOR–name/position

START DATE

END DATE

YOUR POSITION AND DUTIES

REASON FOR LEAVING

NUMBER OF PEOPLE YOU SUPERVISED (if applicable)


COMPANY NAME

ADDRESS OF EMPLOYER

TELEPHONE

YOUR SUPERVISOR–name/position

START DATE

END DATE

YOUR POSITION AND DUTIES

REASON FOR LEAVING

NUMBER OF PEOPLE YOU SUPERVISED (if applicable)

Comments:

Please attach any documentation to further support your application (i.e.; resume or letters of reference)

Resume Attached  No Yes


Applicant Declaration

  • I understand that I must provide reference information upon request.
  • I understand that a Criminal Record Check is a pre-employment requirement with Lamont Health Care Centre.
  • I declare that I am in good health and have no health problems or disabilities which will prevent me from meeting the requirements of the position.
  • I declare that all documentation provided with my application including subsequent written or verbal information is true and complete. I understand that any misrepresentation or omission of fact may disqualify my application or be cause for immediate termination post hire.
  • I understand and agree that should employment be offered, I may be required to pass a functional analysis (at my cost) to ensure I am physically and/or mentally able to perform the duties of the job.

I agree to the declaration:  No Yes