Renfrew Victoria Hospital

Online Application

Personal Information

NAME:

Surname:^*

Given:^*

ADDRESS:

Number:^*

Street:^*

Town:^*

Province:^*

Postal Code:^*

Telephone:^*

() -

Email Address:^*

Positions Applied For:

1.^*

Date Available:^*
^mm/dd/yyyy

Full-Time

Part-Time

Casual

Educational Background:

Type of School	Name & Address	From	To	Graduated (Y / N)	Special Courses or Designations Obtained
Secondary				Yes No
College/University				Yes No
Other				Yes No

Professional Registration:

College:

Registration #:

Date of Most Current Registration:

Prior Work History:

Position	Name & Address of Employer	From	To	Reason for Leaving

May we contact the employers listed above? If not, indicate which one(s) you do not wish us to contact:

Skills & Abilities
Please indicate any special skills, abilities or interests that you believe would be of benefit to the position for which you are applying:

Additional Languages:	Spoken	Written	Level
1.			Elementary Intermediate Advanced
2.			Elementary Intermediate Advanced

Personal Reference:

Name & Occupation or Relationship to You	Address	Telephone Number
1.
2.
3.

Additional Information That You Would Like Us To Know About You:

Attach Your Resume:

Acceptable types are: .doc, .txt. and .pdf only

Have you read the summary of the position description for which you are applying?	Yes No
Do you have any conditions that would prevent you from performing the physical demands the position(s) for which you are applying?	Yes No
Renfrew Victoria Hospital is an equal opportunity employer offering a smoke free workplace. Unsolicited applications for employment are kept on file for a period of 12 months. When all other qualifications for a position are equal, the ability to communicate in both official languages is considered an asset.
I hereby certify that the facts set forth in this employment application are true and complete. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal.

About Us ~ Board of Directors ~ Careers ~ Foundation ~ Visitor Information ~ Need a Family Physician? ~ News & Events ~ Patient Services
Photo Gallery ~ Publications ~ RVH Auxiliary ~ Resource Links ~ Contact Us ~ Home