E-mail: hr@tegh.on.ca Internet: www.tegh.on.

ca

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION
Last name: Street: City: Home Phone: () Province: Alternate: () First Name and Initial: Unit. No. Postal Code: E-mail: Yes No

Are you a current or former Toronto East General Hospital employee or volunteer? If Yes, complete the following, as applicable: Department/Unit: Reason for leaving: Date of Hire:

Date of Departure:

Do you have any relatives employed at Toronto East General Hospital? Name Relationship

Yes

No Department/Unit Yes Yes Yes No No No

Are you legally eligible to work in Canada? Have you been convicted of a federal criminal offence for which you have not received a pardon? Are you age fourteen (14) or over as of todays date?

POSITION(S) AND HOURS OF WORK APPLIED FOR

Please specify availability to work. Date available to start: If No, please indicate availability: 1. 2. 3. 4. days Full-Time Part-Time Casual Summer Yes No Temporary Are you available to work shifts? evenings nights weekends

Please indicate the position(s) you wish to apply for:

We are an equal opportunity employer!

How did you learn of a vacancy at Toronto East General Hospital? Job / Career Fair Employee Referral T.E.G.H. Job Postings Board Professional Journal
Please specify Newspaper Advertisement Please specify. Internet Please specify. Employee name. TEGH Web Site Other: Please specify. List Degree, Diploma or Grade Completed (Ontario Equivalent)

EDUCATION
Level Secondary School: College or Technical: University: Other: (eg. Courses, Workshops, Seminars) Course(s) of Study

REGISTRATION INFORMATION
Do you hold a current Ontario registration for your discipline? Registration number: Expiry date: Yes Yes No No Exam date: (if applicable) Expiry date: Yes No Specify College:

If not, are you eligible for registration in Ontario? Do you hold a current CPR [BCLS (C)] certificate?

For Office Use Only

Verified By: Comments: Verified With: Date:

AREA OF INTEREST
CCU / MICU SICU Acute Cardiac Care Day Surgery Emergency Recovery Room Surgery Complex Continuing Care Operating Room Mental Health Ventilation Weaning Rehabilitation Ambulatory Care Float Pool Medicine Paediatrics Family Birthing Centre Special Care Nursery Haemodialysis Other Please specify:

COMPUTER EXPERIENCE
Microsoft Office Word Other: (Please specify) Excel PowerPoint Access Outlook

EMPLOYMENT HISTORY

Present/Most Recent Employer: Street: Position: Date Employed From: To:

Telephone: () City:

Manager and Title: Reason for leaving:

Final Salary:

Describe primary job responsibilities. Indicate department / clinical area where applicable.

Second Most Recent Employer: Street: Position: Manager and Title:

Telephone: () City: Final Salary:

Date Employed Reason for leaving: From: To: Describe primary job responsibilities. Indicate department / clinical area where applicable.

Third Most Recent Employer: Street: Position: Date Employed From: To:

Telephone: () City: Manager and Title: Reason for leaving: Final Salary:

Describe primary job responsibilities. Indicate department / clinical area where applicable.

REFERENCES 3

Please provide the name of three (3) supervisors/managers who would have direct knowledge of you at your previous or present employer. Provide all information requested. Name Position Organization Telephone 1. 2. 3. Yes No () () ()

May we contact your present employer, if you are currently employed?

CONDITIONS OF EMPLOYMENT
1. I hereby authorize the Toronto East General Hospital to obtain references and information regarding my employment or education as well as other pertinent information which may be available from any or all of my previous employers and/or schools I have attended, in connection with my application for employment. I agree that no liability or damage shall accrue to the above mentioned references as a consequence of their issuing this information. Understood and Agreed Yes No

2. Following a written offer of employment, I recognize and agree to undergo a health review including a physical examination by the Hospital's Occupational Health and Safety Department in order to establish my fitness to perform the essential duties for the position. Understood and Agreed Yes No 3. I will comply with all the rules, policies and regulations pertaining to Toronto East General Hospital . I recognize and agree to have my photograph taken and to wear my photo ID badge for safety and security purposes while on Hospital premises. Understood and Agreed Yes No 4. If offered and eligible, and subject to the terms of relevant collective agreements and Hospital policies, I agree to join the Toronto East General Hospital Pension Plan (HOOPP) and other Benefit Plans after completing the required waiting period. Understood and Agreed Yes No I recognize and agree to receive payment of wages by direct deposit to my account at a participating financial institution. Understood and Agreed Yes No I understand that I will be required to complete a period of probation. Understood and Agreed

5.

6. 7.

Yes

No

Subject to accepting a written offer of employment, I consent to Toronto East General Hospital to conduct a criminal record check. I further consent to Toronto East General Hospital to conduct a criminal record check every three (3) years after commencing employment with Toronto East General Hospital. Understood and Agreed Yes No I understand that any misrepresentation made by me in connection with this application will be just and sufficient cause for termination from Toronto East General Hospital. Understood and Agreed Yes No

8.

Applicant Signature:

Date:

Additional formats of this application are available upon request. NOTE: This document has been prepared in 12pt font