New Team Member Application
Thanks for stopping by! Please have copies of your certifications ready to upload into this intake form when indicated (either as an image or PDF file).
Personal Data
Name
*
First Name
Last Name
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Are you legally eligible to work in Canada?
*
Yes
No
Are you 18 years of age or older?
*
Yes
No
Are you proficient in an additional language?
*
Yes
No
Specify the additional language(s) you are proficient in
*
ex. French, German, Japanese, etc...
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Certifications and Education
If you are a regulated healthcare professional under the Regulated Health Professions Act of Ontario, you will be asked to provide more information on the next page.
Highest Level of Education Completed
*
Secondary School
College or Trade School
University
Other
Program or Major Completed
*
Are you a student of a Health Sciences program (ex. Nursing, Paramedic, Lab Tech)?
Yes
No
What program and institution are you enrolled in?
*
ex. Practical Nursing at St. Lawrence College in Kingston
Current Valid Ontario Driver's License Class (Choose “other” for an out-of-province license)
*
G
G2
G1
Commercial Class (ex. A,B,C,D,E,F)
I do not have a Driver's License
Other
Current and Valid Certifications Held
*
Standard First Aid
First Responder or Emergency Medical Responder Certification
AEMCA or EMA Certification
BLS/HCP Level CPR
ACLS
Instructor Certification
Other
Instructor Certification
Please indicate what you are certified to teach
Attach copies of your certifications here
Browse Files
Drag and drop files here
Choose a file
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Registered Healthcare Professionals
Please complete this section if you are a member of a self-governing health profession as defined by Schedule 1 of the Regulated Health Professions Act of Ontario.
Are you a regulated healthcare professional that is registered to practice in Ontario?
*
Yes
No
What is your professional title and designation?
*
Example: Registered Nurse, RN
What is your registration number?
*
Is your registration current and in good standing?
*
Yes
No
Have you been subject to a disciplinary or statutory decision by your regulatory college?
*
Yes
No
Please provide more information regarding this decision
*
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Employment Experience and History
Resume Upload
Browse Files
Drag and drop files here
Choose a file
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Additional Details
If you have additional information to share, please enter it here
Have you completed a vulnerable sector check in the last 12 months?
*
Yes
No
Please verify that you are human
*
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