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 CONFIDENTIAL
APPLICATION
LIVE-IN
HOUSE
ASSISTANT
Red
= Required Field
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| A
PERSONAL DETAILS |
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Miss,
Ms, Mrs. Mr.
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First
/Given Name(s) :
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Surname
/Family Name :
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Complete Mailing Address
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Street
:
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City
:
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| Province
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| Country
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| Postal
Code : |
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Telephone
- including full local or international code
(daytime)
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Email
:
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Date
of Birth (dd/mm/yy)
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All applicants
other than Canadian Citizens, Landed Immigrants
and Permanent Residents of Canada require a work
permit to be employed by L’Arche.
What is the
expiration date on your passport?
Are you legally
eligible to work in Canada? YES
NO
Do you anticipate
any difficulties in obtaining a work permit?
YES
NO
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If yes, please
elaborate
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Have you
ever been employed by, volunteered in, or
visited a L'Arche community before?
YES
NO
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yes please name the community
here |
| Year(s)
in which I lived in this community |
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B
RELEVANT INFORMATION
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How did
you hear about L'Arche?
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Why
do you wish to come to a L’Arche community?
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How long would you
hope to be in L’Arche?
(We give priority
to those who can commit for at least one year)
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What are your
goals for yourself in coming to L’Arche?
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Have you
read the Charter of
L'Arche? (You can read this document now by clicking on the link here,
you can return to this form by clicking on the
"Back" button at the top of your
browser.)
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When
would you be available to start?
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C EDUCATION,
SPECIAL SKILLS & EXPERIENCE
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Highest
Level of Education completed:
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Field
of Study:
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Have you had previous
experience living or working with people with
developmental disabilities?
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Please
describe any additional education, work, volunteer
or life experience that would be relevant to your
application as a live-in house assistant:
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Do you have current
CPR (Cardio Pulmonary Resuscitation) and First Aid
Certification?
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YES
NO
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Do you have a valid
driver’s licence?
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YES
NO
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Number
of years of insured driving experience
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How would you describe your
ability to speak English?
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How would you describe your
ability to speak French?
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D
HEALTH
Since you will
be providing personal care for individuals who are
vulnerable, we ask that you please complete the
following health questions. If your application is
accepted you will be required to obtain a medical
review before you arrive.
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If the
answer is yes to any of the above, please
elaborate.
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Do you
have any communicable diseases?
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YES
NO
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If so,
please describe:
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REFEREES |
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Please give details
of three referees whom we may contact in
connection with your application. At least one
referee, and if possible all three, should have
known you for more than 3 years. They should
not be members of your family.
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1 This
person must have known you for more than 3
years
Title,
Initial(s) & Family name
Address
Postal
Code
Email:
Telephone
No. (Daytime)
(Evening)
How
many years has this person known you?
In
what capacity?
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2 This
person must have known you in a professional
capacity (e.g. employer, teacher, supervisor,
clergy)
Title,
Initial(s) & Family name
Address
Postal
Code
Email:
Telephone
No. (Daytime)
(Evening)
How
many years has this person known you?
In
what capacity?
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3 Other
Referee (preferably someone who knows you in a
professional capacity)
Title,
Initial(s) & Family name
Address
Postal
Code
Email:
Telephone
No. (Daytime)
(Evening)
How
many years has this person known you?
In
what capacity?
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Is there
anything else you would like us to know with
regard to your application?
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If you wish this application to be forwarded ONLY to specific communities please
list them in the following box
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IMPORTANT NOTE:
Please apply only one time. Your application will
only be processed in one community at a time and
not concurrently. If you are applying on line you
do not need to contact individual communities.
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Applicants should
also e-mail your CV or résumé to: application@larche.ca
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I have read and accept
Part F below YES
NO
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Please,
click here to read the role description
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Thank you for applying
to be an assistant at L’Arche. Please click the
"Submit" button below when you have
completed your application.
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F
DECLARATION
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I
declare that the information given on this form is
to the best of my knowledge true and complete. I
agree to L’Arche taking up any references in
connection with this application and understand
that these will be confidential between the
referee and L’Arche. I also agree to any
Criminal Records Bureau or Police checks which may
be required as part of L’Arche’s recruitment
procedures.
I
agree that the information provided in this
application form may be processed by L’Arche in
relation to my application for this position to
assist in the decision making process. I further
expressly agree that, should it be necessary to
validate any of the information provided therein,
L’Arche may release the information for
verification purposes. If I am successful in my
application, it is agreed that any information
provided will be retained by L’Arche in a secure
and confidential file, and the contents only used
for necessary business purposes, subject to my
express consent for disclosure where necessary.
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OFFICE USE ONLY |
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Issued by
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Date
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Received by |
Date |
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Issue 6 22/03/02 |
Feb. 11, 07
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