Application Form

First Name, Middle Initial *

Last Name *

Prefix *

Ms Mrs Miss Mr Other

Address * City * Postal Code *

Primary Number * Cell Phone Number Email Address

Have you worked for SCF before? *

Yes No

Are you legally permitted to work in Canada? *

Yes No

List positions, dates, and supervisors *

Do you have any relatives currently employed with SCF?

Yes No

How did you hear about Shepherd's Care? *

High School Name *

High School City *

Highest Grade Completed *
Have you graduated from a university or technical institute?

Yes No

Other Special Courses and Skills *

University or Technical Institute *

Degree, Diploma or Certificate Type/Designation * (i.e.: BSc)

Year(s) Attended *

Year Graduated *

Post-Graduate or Extension Courses *

Are you part of a professional Association or Registration?
(Including but not limited to: RN, LPN, Physical Therapist, Recreational Therapist, Occupational Therapist, Pharmacists, Dieticians)

Yes No

Name of Professional Association *

Licensing Body *

Alberta Registration No. *

Registration Province(s) *

Are there current or prior practice conditions or restrictions on your license or practice permit? *

Yes No

Please specify the conditions or restrictions on your license or practice permit: *

Describe any positions of leadership you may have held with committees, community associations, etc. either related or not related to previous employment.

Languages Spoken Fluently

Salary Expectation *

Employer * Address * Phone * May we contact for a work reference?

Yes No

Employed From *

Employed Until *

Reason for Leaving * Position held, duties and salary *

Employer * Address * Phone * May we contact for a work reference?

Yes No

Employed From *

Employed Until *

Reason for Leaving * Position held, duties and salary *

Employer * Address * Phone * May we contact for a work reference?

Yes No

Employed From *

Employed Until *

Reason for Leaving * Position held, duties and salary *

Shepherd’s Care Foundation respects your right to privacy and takes seriously our responsibilities regarding the collection, use and disclosure of your personal information. Shepherd’s Care Foundation wishes you to be aware of the following information.

If you are applying for employment with Shepherd’s Care Foundation, the personal information that you provide will be used to assess your qualifications and suitability as a potential employee. Shepherd’s Care Foundation may also collect and use additional personal information provided by you or your references in the course of evaluation and hiring process.

Your personal information will become part of your employment file if you are a successful candidate. Shepherd’s Care Foundation may collect and use additional information about you, such as criminal record background checks, test scores and performance assessments, for the purpose of managing the employment relationship.

I consent to Shepherd’s Care Foundation collecting and using my personal information for the purposes identified above.

I certify the information I provide in this application is correct and true to the best of my knowledge. I understand that any misrepresentation may disqualify me from employment and/or result in dismissal at any point during my employment.

I Accept *

Resume * (.pdf, .doc, .docx) Cover Letter * (.pdf, .doc, .docx)

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