job application form - Greater Vancouver Community Services Society

Application Form

* mandatory fields

GVCSS job reference number [if any]:

* GVCSS job category: Home Support
Community Living

Step 1: CONTACT INFORMATION

* First Name:

* Last Name:

* Address:

* City:

* Province:

* Postal Code:

* Main phone:

Alternate phone:

Email:

GVCSS employee referral [if any]:

Step 2: EDUCATION

If selected for an interview, you will need to provide documentary evidence of certificates obtained. Please list most recent education first.

Diploma completed:

College attended:

Dates attended:

Diploma completed:

College attended:

Dates attended:

Diploma completed:

College attended:

Dates attended:

* All GVCSS employees must be registered on the B.C. Care Aide and Community Health Worker Registry. No, I have not registered on the Registry.
Yes, I am registered on the Registry.

Here is my BC Care Aide and Community Health Worker registration number:

Step 3: EXPERIENCE [list present or most recent employer first]

Position title:

Employer name:

Dates worked: [from - to]

Description of responsibilities:

Reason for leaving:

Position title:

Employer name:

Dates worked: [from - to]

Description of responsibilities:

Reason for leaving:

Position title:

Employer name:

Dates worked: [from - to]

Description of responsibilities:

Reason for leaving:

Step 4: AVAILABILITY

* A Community Health Worker is required to work shifts that fall within his /her stated availability, unless changes are made according to the provisions in the 2006 – 2010 Community Subsector Collective Agreement.
If a Community Health Worker is no longer available for the shifts agreed upon at this time, he/she may no longer be entitled to shifts.

Date you are available to start:

Open the calendar popup.

* Availability on Mondays: MORNING 7am-12pm (noon)
AFTERNOON 12pm- 5pm
EVENING 5pm-11pm
OVERNIGHT
LIVE-IN
not available anytime on this day

* Availability on Tuesdays: MORNING 7am-12pm (noon)
AFTERNOON 12pm- 5pm
EVENING 5pm-11pm
OVERNIGHT
LIVE-IN
not available anytime on this day

* Availability on Wednesdays: MORNING 7am-12pm (noon)
AFTERNOON 12pm- 5pm
EVENING 5pm-11pm
OVERNIGHT
LIVE-IN
not available anytime on this day

* Availability on Thursdays: MORNING 7am-12pm (noon)
AFTERNOON 12pm- 5pm
EVENING 5pm-11pm
OVERNIGHT
LIVE-IN
not available anytime on this day

* Availability on Saturdays: MORNING 7am-12pm (noon)
AFTERNOON 12pm- 5pm
EVENING 5pm-11pm
OVERNIGHT
LIVE-IN
not available anytime on this day

* Availability on Fridays: MORNING 7am-12pm (noon)
AFTERNOON 12pm- 5pm
EVENING 5pm-11pm
OVERNIGHT
LIVE-IN
not available anytime on this day

* Availability on Sundays: MORNING 7am-12pm (noon)
AFTERNOON 12pm- 5pm
EVENING 5pm-11pm
OVERNIGHT
LIVE-IN
not available anytime on this day

Step 5: COVER LETTER AND RESUME

Attach resume Clear

Step 6: QUESTIONAIRE

* Do you have a Class 4 Drivers License? Yes
No

* Have you been previously employed by GVCSS? No
Yes

If yes, in which year did you leave GVCSS?

* What languages are you fluent in (both verbal and written)?

Are there any other experiences, skills, or qualifications which you feel would especially prepare you for this position?

* As we do have a Nepotism Policy in place, we require applicants to list all relatives and family members working for GVCSS.
Relatives and family members are defined as: spouse, common-law spouse, brother, in-laws, grandparent, grandchild, legal guardian, legal ward, or any other person permanently residing in the same household as you. No, I do not have any relatives/family members working for GVCSS.
Yes, I do have relatives/family members working for GVCSS.

If yes, what is your relative's name:

Relationship to applicant:

* Are you legally entitled to work in Canada? Yes
No

* I hereby certify that the information contained in this application is true to the best of my knowledge. I understand that the Employer may conduct or require an investigation on any matters contained in this application and hereby authorize the Employer to do so. I further agree and understand that any false statements made in this application may cause me to forfeit any claims on my part to employment with this organization. Yes

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