Independent Contractor Application

Independent Contractor Application
Thank you for your interest in joining our team of independent contractors! Please not that by pressing the 'submit' button, you consent to share this information with Community Support Connections.
Date

MonthDayYear
Title
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
*FULL ADDRESS with POSTAL CODE is required to verify availability of nearby client homes as part of our standard recruitment selection process.
E-mail
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
I Currently Reside in
Preferred Areas of Work
Indicate the Amount of Work Wanted
Primary Mode of Transportation
Age Verification
Education Background
Personal Support Worker (PSW) Certification
Previous Work Experience

Type out your answers below.
Employer Name
Job Description
Work Period (Start and End Dates)
Contact Information (Phone or E-mail)
Present Work Experience

Type out your answers below.
Employer Name
Job Description
Work Period (Start and End Dates)
Contact Information (Phone or E-mail)
Current Employment Status
Available to Work:
What is your specific availability, dates & times.
Available for:
If you are available for Yard Work, what equipment do you have access to? (Select all that apply.)
If you are available for Snow Removal, what equipment do you have access to? (Select all that apply.)
Are you eligible to work in Canada?
I am available to begin work:
Previous homemaking/home maintenance experience:
Previous volunteer experience:
Hobbies and interests:
Present Occupation:
Are you a smoker?
Are you comfortable working in a smoking environment?
Are you comfortable working around pets?
Do you have any allergies or health concerns, or are in need of any physical accommodations?
Do you speak, understand, and write in English fluently?
Do you speak, understand, and write any other languages? If so, please specify:
I have no concerns about obtaining a clear VULNERABLE SECTOR POLICE CHECK (VSPC) as required by law.
How did you hear about Community Support Connections?
Emergency Contact

First NameLast Name
Emergency Contact's Phone Number

Area CodePhone Number
Emergency Contact's E-mail
Relationship of Emergency Contact
Personal References do not have to be employers. They can be friends, roommates, classmates, or co-workers BUT they cannot be family-related.
Reference #1
Nature of relationship:
Reference #1 Phone Number

Area CodePhone Number
Reference #1 E-mail
*MANDATORY FIELD
Reference #2
Description:
Reference #2 Phone Number

Area CodePhone Number
Reference #2 E-mail
*MANDATORY FIELD
Reference #3
Description:
Reference #3 Phone Number

Area CodePhone Number
Reference #3 E-mail
*MANDATORY FIELD
Why do you want to work with Community Support Connections? Briefly describe your background, talents & ambitions.
Upload CV or Certification here

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Upload Resume here

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Resumes are not a substitution for our Online Screening Process. ALL WEBSITE APPLICATIONS must be completed fully to be considered — Incomplete Applications will not be reviewed. Cancelof
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Independent Contractor Application

Previous Work Experience

Present Work Experience