Just Like Family Job Application
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Upload your Resume/ CV
Please upload your Resume/ CV
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Certifications
Select all that apply to you
*
LPN/ RN in Canada
RCA (Active and Good Standing)
HCA Graduate
International Nurse (RN in another country)
Care Aides Diploma from other provinces in Canada
Currently a Student in the healthcare industry
Currently a Student (non healthcare related)
none of the above
If you are an RCA, what is your registration number?
*
If you are a student, what are you currently studying?
*
Do you have a class 5/7 Driver's license?
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Class 5
Class 7
No
Do you have access to a vehicle and drive to work consistently?
*
Yes
No
Do you feel comfortable driving clients to their appointment or shopping?
*
Yes
No
Work Status and Availability
Do you have any working hour restrictions?
*
No restriction (Canadian Citizen, Permanent Resident)
Open Work Permit with an expiration date
24 hours per week (Student Visa)
What is the expiration date of your student visa/ work permit?
*
-
Month
-
Day
Year
Date
Will this opportunity with Just Like Family be your only job?
Yes, I will only be working for JLF
No, I am working part time with another company
No, I am currently a student, and will be working part time.
What is your availability? Broken down by day/time including overnight shifts if applicable.
*
Are you trained and willing to perform the following?
*
Rows
Experienced and able to perform the task
No Experience/ Need Training
Not Comfortable
General Personal Care
Bowel Care
Catheter bag replacement and care
Lift operation and Transfer
Motion Exercise with Instruction
Oxygen Tank Operation
Insulin Pen Operation
Nebulizer Administration
Skills And Qualifications
Do you have current and valid certification in the following and are able to provide documentation for:
*
Rows
Yes
No
Criminal Record Check - Vulnerable Sector
First Aid & CPR
Food Safe
WHIMIS
If you are missing any of the above, do you have any obstacles to obtain prior to employment?
*
Yes
No
How many years of caregiver experience do you have in Canada?
*
Please Select
Less than 1
1-3
Above 3
Rate your cooking skills of Western/Canadian Cuisine.
*
1
2
3
4
5
Please list at least 3 Western/Canadian dishes you can confidently cook?
*
Rate your level of experience working with clients with Dementia or Alzheimer's.
*
1
2
3
4
5
Rate your housekeeping skills (cleaning, general tidy, vacuuming etc)
*
1
2
3
4
5
Rate your companionship skills (conversing, socialization and etc)
*
1
2
3
4
5
List 3 activities you like to do with a person who as Alzheimer's or Dementia.
*
Are you comfortable with a male client?
*
Yes
No
Do you have any other skills or qualifications?
*
Do you speak any languages other than English?
*
French
Hindi
Punjabi
Spanish
Mandarin/ Cantonese
Japanese
Korean
Other
Are you comfortable with Pets?
*
Rows
Yes
No
Dogs
Cats
Birds
Are you willing to work at the following locations?
*
Rows
Yes
No
North Surrey
Central Surrey
Surrey Newton
Surrey Cloverdale
South Surrey/ White Rock
Langley City
Walnut Grove/Willoughby
Aldergrove
Brookswood/South Langley
Please Provide at least one Reference
Professional reference preferred
Reference #1
*
First Name
Last Name
Relationship
*
Reference #1 Phone Number
*
Please enter a valid phone number.
Reference #1 Email
*
example@example.com
Do you have a second reference?
Yes
No
Reference #2 Name
First Name
Last Name
Relationship
Reference #2 Phone Number
Please enter a valid phone number.
Reference #2 Email
example@example.com
Please verify that you are human
*
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