Application Form







Position Information


Please indicate any languages other than English that you speak, read or write


High School
Post Secondary

Employment History

List your last three employers beginning with the present/most recent


Attach your Resume

Please attach resume identifying skills, competencies and educational background.


If not already included in your resume, please provide 3 references.

Self Declaration

Southern Health-Santé Sud encourages Aboriginal people to self-identify by completing the voluntary self-declaration below.

Applicant’s Certification and Agreement

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.



Downloadable Documents

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Human Resources

180 Centennaire Drive
Southport, MB R0H 1N1
Tel.: 1-204-428-2747

Physician Recruitment

Box 190
40 Rogers Street
Notre Dame de Lourdes MB R0G 1M0
Tel.: 204 248-7259