Franchise 4011 Application Form
Application Form
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age sex, religion, disability, medical condition, national origin, or marital status.
Personal Information
First Name
*
Last Name
*
Home Phone
*
Work Phone
Mobile Phone
Email
*
Address 1
*
Address 2
City
*
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisana
Maine
Maryland
Massachusetts
Michigan
Military Personnel - America
Military Personnel - Europe
Military Personnel - Pacific
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
U.S. Minor Outlying Islands
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code
*
Driver's License Number
--
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
AA
AE
AP
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UM
UT
VT
VI
VA
WA
WV
WI
WY
Section 1 -
General Information
Position(s) Applying For:
(required)
How did you hear about us?
-- Select an Option --
Advertisement/Job Board
Current CK employee
Website
Employment Agency
Other
Preferred Method of Contact?
(required)
-- Select an Option --
Home Phone
Cell Phone
Email
Other
No Preference
What other languages do you speak?
Section 2 -
Educational Background
Do you have a High School Diploma or GED?
(required)
Yes
No
Do you have a College Diploma or University Degree?
(required)
Yes
No
Do you hold a valid Canadian HCA (or equivalent) qualification?
(required)
Yes
No
Are you currently certified in CPR and First Aid?
(required)
Yes
No
Section 3 -
Employment Information
What date are you available for Employment?
(required)
Have you ever worked for Comfort Keepers in the past?
(required)
Yes
No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodations?
(required)
Yes
No
Are you eligible to work in Canada? (Proof of eligibility will be required.)
(required)
Yes
No
Have you ever been convicted of/or plead guilty to a crime ?
(required)
Yes
No
Do you hold a valid drivers license?
(required)
Yes
No
Section 4 -
Most Recent Employer
Employer
Position/Title:
Summarize the nature of the work performed and job responsibilities:
Supervisor's Name and Title
Supervisor's Phone Number
(Numeric Answer Only)
Section 7 -
Resume
Please use this space to copy and paste your resume, or a portion thereof. Submission of a resume is not an alternative to completing this application form. Only complete applications will be considered.
Show Plain Text
Section 10 -
Applicants Certification and Agreement
I certify that the facts contained in this application are true and complete. I understand that any misrepresentation or falsification of information or significant omissions may carry penalties applicable to my application or employment with Comfort Keepers.
(required)
Yes
No
I understand that, if employed, my employment is not guaranteed for any term, and my employment may be terminated by the employer or myself at any time and for any reason with or without prior notice.
(required)
Yes
No
If I am employed, I agree to comply with and be bound by the safety and health rules and regulations, and rules of conduct of Comfort Keepers.
(required)
Yes
No
This application will remain on active file for 60 days. If I am hired within this period, this form will be transferred to my individual personnel file. If I am not hired or have not heard from this employer within 60 days, this application is no longer active and I will need to reapply for employment if I wish to be considered for a job with Comfort Keepers.
(required)
Yes
No
I give the employer and /or its agents, including consumer reporting bureaus, the right to investigate any and all statements made in this application for the purpose of employment and retention of employment.
(required)
Yes
No
If required, I agree to a drug testing prior and during employment or for post incident investigations.
(required)
Yes
No
The employer, Comfort Keepers, is an Equal Opportunity Employer. The employer does not discriminate in employment and no questions on this application is used for the purpose of limiting or excusing any applicants consideration for employment on a basis prohibited by local, provincial, or federal law.
(required)
Yes
No
I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.
Signature
Submit Application