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Contact Information
Type of Employment Sought
Safety Training

Do you currently have any of the following:

Yes No
Current CPR Level C Certification
First Aide Certification
Food Safe Certification
RAI Certification
Workplace Hazardous Material Information System Certificate
Working Expectations and Restrictions

Are you restricted from working the following:

Yes No
Saturday and Sunday
Summary of Education, Work, and/or Volunteer Experience
Section A - Care Positions to Complete

Please Comment on your experience in the following (If you are applying for Non-Care positions please go to Section B):

Section B - Multi Service worker applicants to complete

Please Comment on Training and Work experience specific to

Section C - Care Aides to Complete

Comment regarding what safety and comfort considerations is needed prior to

Section D - To be completed by RN / LPN

Work History and References

Beginning with your most recent employer, please provide the following information about each employer. This section must be completely filled out by all applicants. DO NOT put 'refer to resume.'

Employer 1
Employer 2
Employer 3

By submitting this form I hereby give AdvoCare Health permission to check employer, educator and Character references.

I certify that the foregoing statements are complete and true. I agree that if there is any failure to disclose or any misrepresentation of my material fact required to be stated in the foregoing statements, AdvoCare Health Services may terminate my contract of employment and all benefits arising from it shall be void from the commencement.

This serves as confirmation that I have reviewed, understand and agree to the content noted on this application.

Advocare Health Services

1450 St Paul Street
Kelowna, BC
V1Y 2E6

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