PCLS Inc.

Employment Application

*Please note that all fields must be complete in order for your application to be accepted.*

Your Contact Information

First Name	Last Name

E-mail Address	Phone

Home  Address	Please check
Male Female

Which position are you applying for?

How did you learn of this
opening?	Referral name:

Have you ever been employed by PCLS Inc? If yes, when?

 	

Are you legally entitled to work in Canada?
Yes No

Do you hold a study/work permit? (If required)
Yes No

Do you hold a valid driver's license?
Yes No

What form of transportation do you use?
Bus Vehicle

Do you have any physical/medical limitations to performing this job?
Yes No

If so, please indicate

Have you ever been convicted of a crime?
Yes No

If so, please explain

As a condition of employment, a valid Criminal Record Check, Child and Adult Abuse Registry Check MUST be completed. If chosen for an interview, you will be required to submit all updated forms. All forms MUST be dated no later than 3 months from the interview date.

Please check the boxes below if you have the following updated documentation:

Criminal Record Check (with vulnerable sector search) Adult Abuse Registry Check
Child Abuse Registry Check 
First Aid/CPR  
Nonviolent Crisis Intervention (NVCI)
I authorize Pulford Community Living Services Inc. staff to check my past employment and education for verification and suitability for this applied position. I certify that to the best of my knowledge and belief, the answers given by me to the foregoing questions and the statements made by me are truthful. Any false answers may result in my discharge. I hereby release all employers, schools and individuals from any liability for any damage whatsoever resulting from giving such information.

It is understood: should you be employed there will be a period of thirty (30) days during which time notice may be given by either party for immediate termination without reason.

Date:	Signature of Applicant:

The Human Rights Code prohibits discrimination in employment based on ancestry, age, ethnic background  or origin, religion or creed, nationality or national origin, sex, gender identity, sexual orientation, marital or family status, source of income, political belief, social disadvantage, physical or mental disability.