Tidal View Manor

O/A “The Meadows”

339 Pleasant Street

External Application Form
YARMOUTH, NS, B5A 2K9

Telephone: (902) 881-3399

Fax: (902) 742-1426

Please complete this application as fully as you can, and attach a current resume.
Position Details
(Please print in ink or type)
Position applied for:
Competition No.:

How did you hear of this position?

Date available for employment:

Expected salary:

Please Indicate:
(Check all that apply)
Type of employment desired: ( )Full-Time ( )Part-Time
( )Temporary ( )Casual
When you will be available: ( )Day ( )Evening ( )Weekend
( )Shift Work ( )Statutory Holiday

Personal Information
Name:

(Last) (First)
(Initial)
Address:
City/Town:

Province: Country:
Postal Code:

Telephone Number: ( ) E-mail Address:

Are you legally eligible to work in Canada?

( ) Yes ( ) No
Are you 16 years of age or older?
( ) Yes ( ) No
Are you recorded on the Child Abuse Registry?
( ) Yes ( ) No
Have you ever been convicted of a criminal offence,
( ) Yes
( ) No
for which a pardon has not been granted?
If yes, please describe briefly the circumstances of your conviction, indicating
the date, nature, and place of the
offense and disposition of the case.
If hired by TVM, I will sign an agreement to observe and comply with
( ) Yes ( ) No
all policies and procedures of Tidal View Manor.
Education
Name of School
Credential Obtained
Education Level
(Name of High School is Optional)
(Grade, diploma, degree, etc.)
High School or Equivalent

College / Technical Training

University

Other related education / training

Please specify any certificate, license or other authorization to practice a
profession or trade which you possess
and if applicable, indicate the professional association, registration number and
year of renewal.
 Employment History
(Please start with most recent; if more space is required, attach an
additional sheet)
Name of Company: Address:

Position Title: Final Salary:

Telephone Number: ( ) Manager or Supervisor’s

Name:

Start Date (MM/YYYY): End Date (MM/YYYY):

Duties and Responsibilities:

Reason for Leaving:

Employment History
(Please start with most recent; if more space is required, attach an
additional sheet)
Name of Company: Address:

Position Title: Final Salary:

Telephone Number: ( ) Manager or Supervisor’s

Name:

Start Date (MM/YYYY): End Date (MM/YYYY):

Duties and Responsibilities:

Reason for Leaving:

May we contact your former or present employer for reference

( ) Yes
( ) No
purposes?
If no, please explain:

Work-Related References
Please list two persons whom you reported to directly (Manager or Supervisor) for
at least 6 months, which can be
used for reference purposes:
Name: Title: Telephone
Number: ( )

Name: Title: Telephone

Number: ( )
I hereby declare that the foregoing information is true, complete and correct to
the best of my knowledge. I
understand that any omission of information requested, or any false or misleading
information could lead to
withdrawal of this application or termination of my employment with cause, and
without notice or any further
payment. I also agree to submit to a physical examination, and to participate in
the Employee Benefit plans of the
Tidal View Manor The Meadows” where such participation is compulsory under the
terms of the plan.
Note: Breaches of Confidentiality, Theft, Abuse of Residents (verbal, emotional,
physical), Bullying of
Residents and/or Staff including Volunteers, and Visitors, will not be tolerated
and are grounds for
immediate dismissal.
By signing this application form, I certify that I have read the terms of the above
employment understanding.

Applicant Signature Date