Support Worker Screening Form

Facebook

Please fill out the fields below.

Name

Email Address *

Phone Number

What you do know about the Support work Program?

How did you hear about the Support Work Program? Website Word of mouth Career Fair Other

If you were referred to us, who referred you?

Would you like to self-declare (First Nation, Metis, Inuit)? Yes No

If you selected Yes above, what community?

Valid Manitoba Drivers Licence? Yes No

Own a Vehicle/Access to a Vehicle Yes No

Do you have a satisfactory Background Checks (Background checks are condidered current as of 3 Months)

Proof of Vaccination Yes No

Certification and Training: (Do you have any of the following: CPR First Aid Training NVCI Suicide Prevention None

Availability Days Evenings Weekends Anytime

When is the best time to call for a follow-up from our staff?

Anything else you would like to add? *

Do you have a resume? If so please attached

This email address is being protected from spambots. You need JavaScript enabled to view it.