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Employment Application Form

Position Applied for:
Name:		Phone Number :
E-mail Address:
Current Address:
Previous Work Experience: Attach Resume: Word, Text or RichText only.
Name and Address of Present Employer/Contact Person:
Please provide us with a brief summary of your education, qualifications, training and special skills:
Reason for applying for this job:
Please provide us with the name and phone number of your references (Three), one must be current or past employer: 1. 2. 3.
For employment reference, we may approach; Your present/last employer? Yes: No: Your former employer? Yes: No:
Are you legally entitled to work in Canada?: Yes: No:
Are you 18 years of age or more?: Yes: No:
Have you ever been convicted of a criminal offence for which a pardon was not granted?: Yes: No:
Most of our jobs require entering people's homes. It is policy of Dorvict Resources and Consulting Centre Inc. to request/for police clearance certificates from all our employees. If employed, are you willing to provide us with a police clearance record?: Yes: No:
I hereby declare that the foregoing information is true and complete to my knowledge. I understand that false statement may disqualify me from employment of cause for dismissal.

Dorvict Resource & Consulting Centre Inc. /Dorvict Home and Health Care Services