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Intercare Corporate Group Inc - Calgary Alberta

Employment Application

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Personal Information                                 
First Name: Last Name:
Address:
City: Province:
Country: Postal Code:
Phone: Cell: (optional)
Email: (optional)    
Are you eligible to work in Canada?
yes no
How did you hear about us?
Intercare Website Word of Mouth
Calgary Herald Workopolis
Monster Career Fair
Educational Institute Canada Job Bank
Other
Have you every been employed by Intercare?
yes no
Date Range:    
Reason For Leaving:    
Do you have any relatives employed by Intercare?
yes no
Name of Relative:    

Thank you for your interest in employment with Intercare Corporate Group Inc. At this time, we are only accepting applications from those candidates who are currently eligible to work in Canada.

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Position Information
Position Applying For:
Administration/Clerical Residential Services (Housekeeping/Food Services/Laundry/Cook)
Dietitian Recreational Therapist
Health Care Aide / Resident Care Aide Registered Nurse
Licensed Practical Nurse Social Worker
Maintenance Therapy Aide
Management Unit Clerk
Occupational Therapist Other (Please specify position at end of application form)
Physiotherapist    
   
Location Desired:
Brain Injury Unit (Southwood) Corporate Office (administration)
Brentwood Care Centre Intercare @ Millrise
Chinook Care Centre Southwood Care Centre
Chinook Hospice Southwood Hospice
Type of Work Preferred:
Full Time Part Time Casual
Shift Preference:
Days Evenings Nights
Ability to Work:
Monday Tuesday Wednesday
Thursday Friday Saturday
Sunday        
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Dietitian

Do you hold a current registration with the College of Dietitians of Alberta?     YES    NO
Do you have you previous experience working in Long Term Care or Hospice environment?    YES    NO
Health Care Aide /
Resident Care Aide
Health care aide certificate achieved? YES    NO
School / College attended
Year Graduated
Are you able to work a minimum of four (4) shifts per month?  YES    NO
Unit Clerk
Unit clerk certificate achieved? YES    NO
School / College attended
Year Graduated
Do you have previous experience working in a
Long Term Care or Hospice environment?		 YES    NO
Licensed Practical Nurse
Do you hold a current registration with the CLPNA? YES    NO
Are you able to work a minimum of four (4) shifts per month? YES    NO
Do you have you previous experience working in Long Term Care
or Hospice environment?		 YES    NO
Occupational Therapist
Do you hold a current registration with the Alberta College
of Occupation of Therapists?		 YES    NO
Do you have you previous experience working in Long Term Care
or Hospice environment?		 YES    NO
Physiotherapist
Do you hold a current registration with the College of
Physiotherapists of Alberta?		 YES    NO
Do you have you previous experience working in Long Term Care
or Hospice environment?		 YES    NO
Registered Nurse
Do you hold a current registration with CARNA? YES    NO
Are you able to work a minimum of four (4) shifts per month? YES    NO
Do you have you previous experience working in Long Term Care
or Hospice environment?		 YES    NO
Residential Services
Are you able to work a minimum of four (4) shifts per month? YES    NO
Do you have you previous experience working in Long Term Care
or Hospice environment?		 YES    NO
Social Worker
Do you hold a current registration with ACSW? YES    NO
Do you have you previous experience working in Long Term Care
or Hospice environment?		 YES    NO
Therapy Aides
Do you have a minimum of two year’s experience as a Therapy Aide? YES    NO
Maintenance
Do you have a minimum of two year’s experience in Maintenance? YES    NO
Administration / Clerical
Have you had previous experience working in Long Term Care? YES    NO
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* Evidence of educational qualifications will be required prior to commencement of employment.
Education and Training
High School
Name of Institute:
City, Country:
Highest Grade:
Year Completed:
Post Secondary Education
Technical School College University Other
Name of Institute:
City, Country:
Program/Major:
Year Completed:  
Diploma/Degree Achieved? YES    NO
Computer Skills
Word Excel Outlook PowerPoint
MDS Other    
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Employment History

Last Position

Employer:
Address:
City/Province:
Country/Postal:
Position Held:
From (yyyy/mm):
To (yyyy/mm):
Duties:
Reason for Leaving:

Second Last Position

Employer:
Address:
City/Province:
Country/Postal:
Position Held:
From (yyyy/mm):
To (yyyy/mm):
Duties:
Reason for Leaving:

Third Last Position

Employer:
Address:
City/Province:
Country/Postal:
Position Held:
From (yyyy/mm):
To (yyyy/mm):
Duties:
Reason for Leaving:
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References (minimum of 2 work-related references)

DECLARATION: 
I am applying for employment with Intercare Corporate Group Inc. and I hereby authorize my previous employers/references to release personal, employment related and/or educational information to Intercare Corporate Group Inc.       YES    NO

Reference One

Name:
Title:
Company:
Phone:
Email:

Reference Two

Name:
Title:
Company:
Phone:
Email:

Reference Three

Name:
Title:
Company:
Phone:
Email:
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Resume
Attach Cover Letter
Attach Resume
Additional Information (is there any additional information you would like to bring to our attention?)
 
Declaration and Conditions of Employment
  1. I declare the statements made by me in this application are, to the best of my knowledge, true.  I realize that any false statement made deliberately will be grounds for dismissal.  I also understand that, if hired, I must successfully complete a probationary period.
  2. I declare I have made known any physical and/or mental restrictions that may affect my ability to do the duties of the position(s) I have applied for. 
  3. I understand that obtaining a security clearance, i.e. A satisfactory criminal record check, including a vulnerable sector search, is a condition of employment. I understand that I may need to complete two (2) Record Checks and understand it is my responsibility to pay all costs related to obtaining a criminal record check through Calgary Polices Services, and Intercare will pay all costs related to obtaining a criminal record check through any third party providers.
  4. I understand that, to protect the health of our residents and staff, I am required to have an annual flu immunization which is available at no charge, at the Care Centre.
  5. I understand that, to protect the health of our residents and staff, and in compliance with Alberta Health Infection Control standards, I am required to provide a copy of my Tuberculosis or Chest X-Ray paperwork (this may be obtained from a Tuberculosis Clinic) within 30 days of date of hire. 
  6. I understand that unless authorized by the Facility Leader or Designate, I will be required to attend Intercare’s General Orientation session(s) with the Education team prior to commencing orientation in the job classification for which I have been hired.
  7. I agree to arrive to work prior to the start time and leave no earlier than the completion time for all scheduled shifts I accept.  Should I not fulfill this obligation and commitment, I understand that Intercare will review my suitability as an employee of this organization.
  8. I understand that the personal information I have provided/submitted herein may be used for the purpose of employment only, and conforms to Section 32 of the Freedom of Information and Protection of Privacy Act. 

I declare, understand and accept the above noted conditions of employment       YES    NO                    

 

 
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