Caretaker / Maintenance Staff Application Form

Caretaker / Maintenance Staff Application
Mission Statement of Regina Catholic Schools

The Mission of the Regina Roman Catholic School Division is to work with the community and the local church to provide a quality Catholic education which respects the diversity of all staff, students and families and fosters academic excellence and the development of faithful, informed, responsible citizens.
Notice to Applicants

Please supply all information requested in each section of the application form, wherever possible.
General Information
Name in Full*

PrefixFirst Name(First Name)
E-mail Address*
Cellphone Number

Area CodePhone Number
Fax Number

Area CodePhone Number
Telephone Number

Area CodePhone Number
Present Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Social Insurance Number*
Religion:
Languages spoken other than English:
How did you learn of the position?*
Name and address of next of kin: (please use a comma (,) to separate entries)*

Please list the most recent employer first

	Name and Address of Employer (use a comma (,) to separate entries)	Position Title	Employment Period	Supervisor (please include phone #)
Location #1
Location #2
Location #3
Location #4

Position Requirements
Fireman's Certificate*

YesNo
Declarations

I certify that the statements made by me in the application are, to the best of my knowledge and beliefs, true and complete and are made in good faith. I understand that if any of these statements are untrue this application may be rejected and that my appointment to a position may be rescinded.
Signature of applicant:
Date of Application:

MonthDayYear
I provide consent for RCSD to send any job postings to my personal email address provided above.

YesNo
Should be Empty: