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Home Care Service & PSW Staffing in Toronto, Ontario - psw jobs in toronto



UMS APPLICATION FAX OVER TO 416.495.9001 OR EMAIL @ info@umsmed.ca TODAYS DATE________________APPLICANT INFORMATION Last NameFirstPosition:Street AddressApt/Unit #CityProvPostal CodePhoneD.O.BSocial Insurance No.E-mail AddressAVAILABILITYWhen can you start?Desired Salary $Available Full time Part time Temporary Permanent Summer Shifts 7-3 3-11 11-7 7A-7P 7P-7A Other_______EDUCATIONPSW School:Any other degree:From ToDid you graduate? YES NO CollegeDegreeFrom ToDid you graduate? YES NO Post GraduateDegreeFrom ToDid you graduate? YES NO VACCANATIONS - Hepatitis B Vaccine Status I have received the complete series I decline at this timePREVIOUS EMPLOYMENT CompanyPhone ( )AddressSupervisorJob TitleStarting Salary $Ending Salary $ResponsibilitiesStart Date / / End Date / / Reason for LeavingMay we contact your previous supervisor for a reference? YES NO CompanyPhone ( )AddressSupervisorJob TitleStarting Salary $Ending Salary $ResponsibilitiesStart Date / / End Date / / Reason for LeavingMay we contact your previous supervisor for a reference? YES NO CompanyPhone ( )AddressSupervisorJob TitleStarting Salary $Ending Salary $ResponsibilitiesStart Date / / End Date / / Reason for LeavingMay we contact your previous supervisor for a reference? YES NO REFERENCESPlease list three professional references – NO FAMILY MEMBERS PLEASE1. Full NameRelationshipPhone ( )2. Full NameRelationshipPhone ( )3. Full NameRelationshipPhone ( )QUESTIONSPlease check YES or NO to the following questions.Have you ever been convicted of a crime that would prevent employment at a health care facility? If yes, please provide details on a blank page.YES NO Have you ever been convicted of a crime which resulted with you being in prison and released from prison or paroled? If yes, please provide details on a blank page.YES NO Do you have more than 1 year experience in the health care field?YES NO Do you have a legal Driver’s License?YES NO Do you own a vehicle?YES NO Are you a Canadian Citizen?YES NO Can you provide all current License or Certifications?YES NO SKILLS: Please check where proficient.CLERICAL SKILLS:E-marSurgePoint Click CareHOSPITAL FLOORS:Med/SurgMother/BabyNeurologyNurse ManagerOncologyOrthopedicsRehab/SkilledPediatricsPsychiatricRadiologyRETIREMENT/ NURSING HOME:Ministry of Labor Obligations Training Ministry of Health/Abuse & AggressionCrisis Prevention Intervention Training (CPI)Whistle BlowingWHIMIS – Fire SPECIFIC CLINICAL:DialysisPhlebotomyIV Insertion PedIV Insertion AdultEKG InterpretationVentilatorsVitalsInjectionsALT. NURSING:Occupational HealthRisk ManagementInsurance CompanyLegal ReviewDirector of CareNurse ConsultantTelephone TriageStaffingDISCLAIMERI certify that all statements made in this application are true to the best of my knowledge. I understand that any falsification or misleading information given in my application may result in the termination of my employment with United Med Staffing Inc. Furthermore, I understand that my professional conduct and clinical performance is directly related to my ability to be placed on assignments for United Med Staffing Inc. I am also aware that I may be an employee of UMS or a sub-contractor for our company UMS. I authorize UMS to verify the information I have provided, and to conduct references concerning my ability, character, and past employment record. I agree to follow the policies and regulations of the College of Nursing of Ontario Guidelines and the Regulated Health Professions Act. SIGN:_____________________________________ DATE:__________________________NON-COMPETE FORMThis is a NON-COMPETE Agreement between employee and United Med Staffing. United Med Staffing is introducing you to one of its clients in good faith with the understanding that you as a United Med Staffing employee/contract worker are not allowed to work for the client or any other agencies within the client’s facility for period of 365 days of last date worked for United Med Staffing. To do so would be a breach of this agreement and there for you would be responsible in paying United Med Staffing a fee; your hourly rate times 10 x 90 days. You will also be responsible for all legal and collection Fee’s. By signing this agreement, you understand that you are signing a NON-COMPETE Agreement with Untied Med Staffing. This agreement does not allow you to work for any of our clients that we have introduced you to, within their facility or any other agency working in the facility. Sign: ________________________ Date: ____________________Print Name: _________________________