Appletree Medical Group - Ottawa Physicians, Family Doctors, Ottawa Walk in Clinic, Medical Clinic, Health Directory

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	Appletree Employment Application
	Applying for prefered location:

PERSONAL INFORMATION

	*	Last name:
	*	First name:
		Middle name:
	*	Phone:	( ) - ext:
		Cell Phone:	( ) -
	*	Email:
	*	Present Address:
	*	City:
	*	Province:
	*	Postal Code:	-
	*	Do you have previous medical office or clinic experience?	Yes \| No
		Position Applied for:	Medical Assistant Team Leader Trainer Sales & Marketing Transcriptionist Stress Testing Technician Accounting Department
	*	Part/Full Time:	Part Time \| Full Time
		Special Training or Education:	CPR WHMIS Sclerotherapy Transcription ECG\'s, Holters, Event Monitors Orthotic Assessments Audiometry Sales Training Registered Nurse Registered Practical Nurse International Medical Graduate (MD) Commerce/Accounting/Business Courses Call Center Experience
	*	Date of availability:
	*	Are you presently employed?	Yes \| No
	*	Are you willing to do a volunteer period?	Yes \| No
	*	Salary Expectation:	$10.00/hr $10-12/hr $12-$14/hr $30K-$40K $40K-$50K $50K+
	*	Vehicle Status:
	*	Have you ever worked for Appletree before?	Yes \| No
		Referred By:
		If you are under 18, please state your age: *Please Note: You may be required to provide proof of age prior to hire.
	*	Have you ever been convicted of a criminal offence for which you have not been pardoned?	Yes \| No
	*	Are you legally entitled to work in Canada? (You may be required to provide proof of employment status prior to hire.)	Yes \| No

AVAILABILITY

HOURS AVAILABLE	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SATURDAY	SUNDAY
*From:
*To:

EMPLOYMENT BACKGROUND
List your present or last position first

Please note: This information is confidential. We will not contact your current employer without your permission.

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Company Name:
Address:
Telephone:	( ) - ext:
Name of Supervisor:
Position of Supervisor:
Your Position:
Salary/Wage	Start: End:
Reason for Leaving:

From:

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Company Name:
Address:
Telephone:	( ) - ext:
Name of Supervisor:
Position of Supervisor:
Your Position:
Salary/Wage	Start: End:
Reason for Leaving:

From:

To:

Company Name:
Address:
Telephone:	( ) - ext:
Name of Supervisor:
Position of Supervisor:
Your Position:
Salary/Wage	Start: End:
Reason for Leaving:

Education BACKGROUND
List your present or last schooling first

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To:

Institution Name:
Program Name:
Course Award: default:Diploma	Diploma Certificate Undergraduate Degree
Completed:

From:

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Institution Name:
Program Name:
Course Award: default:Diploma	Diploma Certificate Undergraduate Degree
Completed:

From:

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Institution Name:
Program Name:
Course Award: default:Diploma	Diploma Certificate Undergraduate Degree
Completed:

Upload resume:
Note: please make sure there are no spaces in your file name. You might need to rename your file.

I declare that the information contained in this application is correct to the best of my knowledge and understand that any omission or incorrect information is just cause for the rejection of my application or dismissal in accordance with the Company policy. If hired, I understand that I may be transferred to another location because of promotions, training or staffing requirements. I also agree that, at all times, I will follow the rules and regulations of the Company. I authorize the Company, or its agents, to verify the information provided, and to obtain any other information relevant to this application. This information may be obtained by telephone or in writing from educational institutions, my current or former employers, financial institutions, personal information agents and my personal references. This consent is valid during the consideration of my application for employment, and if I am hired, for the duration of my employment.

To the applicant:
Your application will be considered active for 90 days, after which you must submit a new application. The information which you have supplied, and any other information obtained, will be used solely for the assessment of your application for employment. Your application will be kept by the Management Team and, if you are hired, it will become part of your employee file. Your file will be retained in the Manager's office, and may be accessed by Management. You may access your file by appointment with a representative of the Company. If there are mistakes in your file, you have the right to ask for them to be corrected.