The Good Samaritan Society
On-Line Application for Employment

 

Position Applied For:                               

Employment Opportunity Number:

Employment Preference: Full Time    Part Time    Casual    Temporary    No Preference

Personal Information:

Name (last)* (first)*
Address (apartment/street/city/province/postal code)*
Phone Number* Alternate Phone Number
Date Available Hours and Days Preferred Location Preferred

Are you presently employed with The Good Samaritan Society?  Yes    No    If Yes, current status:  FT    PT    Casual    Temp.

Are you legally entitled to work in this Province?    Yes    No

Are you legally entitled to work in Canada?    Yes    No

Have you worked previously for The Good Samaritan Society?    Yes    No    If Yes, give dates: 

How did you learn of this position? 

Note:  
The Education, Employment History and References should only be completed on-line if not attaching a resume.  Please proceed to the bottom of this form.

Education:

  Name & Location of School Years Attended Date Graduated Completed
Degree/Diploma/Certificate
HIGH SCHOOL
UNIVERSITY/COLLEGE
RELATED COURSES
 
Professional Registration #
(R.N., L.P.N., P.T., O.T., R.T.) 		Current Status
Active:  Yes    No		 Expiry Date:   Associate    Not Registered

Employment History (Start with your most recent employment.)

Company Name: 
Company Address: 
Dates (include month and year):  From:            To: 
Position: 
Supervisor (name and title): 
Brief Description of Duties: 
Reason for Leaving: 
 
Company Name: 
Company Address: 
Dates (include month and year):  From:            To: 
Position: 
Supervisor (name and title): 
Brief Description of Duties: 
Reason for Leaving: 
 
Company Name: 
Company Address: 
Dates (include month and year):  From:            To: 
Position: 
Supervisor (name and title): 
Brief Description of Duties: 
Reason for Leaving: 

Employment References
Name used (if applicable) in previous employment for the purpose of reference checks: 

Name Title Employer Phone #


By Submitting This Application On-Line, I authorize The Good Samaritan Society (GSS) to obtain references from past and present employers (as indicated at right) and I release GSS from liability or damages incurred as a result of any inquiry made and the furnishing of this information.

 Your Present Employer:  Yes   No

Your Former Employer:   Yes   No
   
I certify that the statements made by me in this application are true, accurate and complete.  I understand and agree that a false statement may disqualify me from employment or result in dismissal.  It is understood if employed that I will accept all conditions of employment set out by The Good Samaritan Society.