Partners in Community Nursing Initial Application
This is our initial application form. If your application passes this screen, our team will contact you to continue the process. If you do not pass this screen, you will not receive a follow-up message.
Basic Information
Applicant Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Position applying for:
*
RPN
RN
Program preference:
*
Visiting Program
Shift Program
School Program
If applying to the Visiting Program: Can you be available full-time during orientation (min. 3 weeks, includes weekends)?
*
Yes
No
Employment type:
*
Full-Time
Part-Time
Casual
How many hours/days are you looking to work each week?
*
If weekly hours vary please provide context
How many weekends are you available to work in each 4-week period?
*
One
Two
Three
Four
Other
Are you available for (select all that apply):
*
Days
Afternoons
Evenings
Weekends
Are you currently registered and in good standing with the CNO?
*
Yes
No
Other
Do you have a valid driver’s licence (min. G2)?
*
Yes
No
Other
Do you have access to an insured vehicle for work?
*
Yes
No
Other
Are you comfortable travelling across Durham Region (Pickering → Newcastle; north to Sunderland/Zephyr/Port Perry)?
*
Yes
No
Other
Resume Upload
Upload your resume (PDF or DOCX)
*
Browse Files
Drag and drop files here
Choose a file
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of
Acknowledgement
Consent Signature
Date Signed
*
-
Month
-
Day
Year
Date
How did you hear about PICN
*
Google/Internet Search
ChatGPT/Ai Search
LinkedIn
Facebook
Word of Mouth
Other
Submit
Should be Empty: