Are you legally entitled to work in Canada?
Are you aware of any health or physical conditions that could affect performance on the job?
Are you currently employed with Southern Health-Santé Sud?If yes, please list facility/program and dates
Have you ever been employed by Southern Health-Santé Sud or any of its affiliates?If yes, please list facility/program and dates
Are you bilingual (English/French)?
Position(s) Applied For
Please indicate any languages other than English that you speak, read or write
List your last three employers beginning with the present/most recent
Please attach resume identifying skills, competencies and educational background.
If not already included in your resume, please provide 3 references.
Southern Health-Santé Sud encourages Aboriginal people to self-identify by completing the voluntary self-declaration below.
I declare myself to be Aboriginal descent.
I declare the foregoing information to be true and complete to the best of my knowledge and understand that any misrepresentation or material omission is grounds for refusal to employ me or, if I am employed, for dismissal with cause.
If employed I agree to abide by the policies, procedures and working conditions established and/or amended from time to time by Southern Health-Santé Sud. I hereby authorize Southern Health-Santé Sud to conduct a personal investigation in connection with my application for employment including a Criminal Record Check, Vulnerable Sector Search, Child Abuse Registry Check and Adult Abuse Registry Check. All costs associated with these checks will be my responsibility.
I hereby authorize my current or former employers to release information regarding my record of employment, performance on the job, reason for leaving (if applicable) and other pertinent information.
180 Centennaire DriveSouthport, MB R0H 1N1 Tel.: 1-204-428-2747 email@example.com
Box 19040 Rogers StreetNotre Dame de Lourdes MB R0G 1M0 Tel.: 204 248-7259 firstname.lastname@example.org
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