Job Application Position or Type of Work Applied for:*PERSONAL INFORMATIONName* Given Names Last Address* Street Address Address Line 2 City Province Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Desired Employment:* Full-Time Part-Time Casual Temporary Until what date* MM slash DD slash YYYY Have you previously been employed by Vital Society?* Yes No Have you worked with a CSSEA member within the previous 12 months?* Yes No Have you obtained your Community Support Worker Diploma?* Yes No CSW Certification Date:* MM slash DD slash YYYY Do you have a valid First Aid (Emergency First Aid Community Care Level, or higher)?* Yes No Have you had a tuberculosis (TB) test within the last 6 months?* Yes No Do you have a Class 5 Driver License (or higher)?* Yes No Are you legally entitled to work in Canada?* Yes No Have you had a criminal record check done within the last year?* Yes No WHAT YOU'LL NEEDIf you are a successful applicant after an interview, these are the requirements for the position: New Hire Pre-requisitesRESUMEUPLOAD YOUR RESUME HEREAccepted file types: jpg, png, pdf, Max. file size: 256 MB.FREEDOM OF INFORMATION/PROTECTION OF PRIVACY:Vital Society complies with the legislation in the Province of British Columbia. The information collected on this application will be used to determine eligibility for employment with Vital Society. If the applicant accepts an offer of employment the information provided in this form will be kept in the employees personnel file and may be referred to for the purpose of the employment. Disclaimer - Read Carefully Before Signing or Submitting Your Application ElectronicallyI certify, agree and understand that all information supplied on this application is true and I understand that any untrue statements will be grounds for termination of my employment at any time during my employment. In connection with this application, I authorize all organizations, companies, credit agencies, persons, educational institutions, law enforcement agencies, government departments, current and former employers to release information they have about me and release them from any liability from doing so. I accept the purpose of the information gathering is to determine my suitability for employment. If you are the successful applicant, we will be making a conditional offer contingent upon a cleared criminal record check result under the Criminal Records Review Act. At the time of offer, you will need to provide consent for a criminal record check. Once a clearance is received, your offer of employment will be confirmed. I further understand that appointment is dependent upon: (a) Successful completion of a probationary period, if applicable, (b) Contacting my previous employers to obtain satisfactory reference checks. (c) A satisfactory criminal check, if applicable (d) A valid BC Class 5 Drivers License(if required for position). A Class 4 is required within three months of hire date.By submitting this application I agree this application is binding by law* Agree Captcha
