Page 1 of 3NameFirstLastPhone Number:*Email address*I understand that all my personal information will be kept confidential *YesGender*MaleFemaleOther/DisclosedDate of Birth (MM-DD-YYYY)*Type of Professional:*Please selectRNRPNPSWDietary AideCleaning AideCNO Registration Number (if applicable)Certificate Upload (if applicable)NextUpload most recent CPR CertificateBackNextThe information I have provided in this application is accurate and fully disclose my background, education and work history and that I can perform all duties of the job as provided in the job posting.*I declare that all the following points are True.I hereby declare that, to the best of my knowledge, • I am free from communicable diseases that may be transmitted from person to person. • I am physically and mentally fit and able to undertake the assigned works set out in my job. • There are no medical restrictions and/or accommodations required in order to perform my job duties.Do you agree to authorize and pay for a third party completion of a criminal record check prior to your employment ?*YesNoMay your present supervisor be contacted for a work reference ?*YesNoAre you or will you agree to be fully vaccinated against COVID-19 prior to starting a job at Supreme Pro Staffing ?*YesNo(The only exemption is on a medical ground pursuant to the Ontario Human Right Code.)Please type Your Name here as Your Digital Signature *Supreme Pro Staffing Confidentiality Declaration *I declare that all the following points are True.WHEREAS the undersigned is or has agreed to become a contracted employee of Supreme Pro Staffing Inc. (herein referred to as the Company), AND WHEREAS the undersigned may come into possession of or generate information of a confidential nature relating to the operations and management of the Company including but not limited to resident and client records, AND WHEREAS it is acknowledged and agreed that it is critical to the interests of the Company and those whom it serves, that the confidential nature of such Confidential Information be maintained and protected, The undersigned agrees to maintain all Confidential Information in the strictest of confidence and shall not disclose any Confidential Information or any part thereof to any other person or entity without the prior written consent of the Company, or except as provided by law. The undersigned hereby covenants, agrees and acknowledges that the Confidential Information is the sole property of the Company and is not to be removed from the Company’s premises without the prior written consent of the Company. The undersigned hereby agrees that he or she will not use the Confidential Information for his or her own benefit or purposes, nor for the benefit or purposes of any third party. The undersigned shall not at any time, copy, photocopy, scan or otherwise reproduce for distribution in any form, modify or create derivative works of the Confidential Information without the prior written consent of the Company. The undersigned shall, at the request of the Company, or in case, at the termination of undersigned’s involvement or association with the Foundation, return all Confidential Information in the possession the undersigned. The undersigned shall, at the request of the Company, provide the Company with a certificate certifying as to the complete return of all Confidential Information.BackSendThis field should be left blank