Employment application formVitalis Comprehensive Healthcare & Vitalis Surgical CentreEmployment Application FormThank you for your interest in joining Vitalis Comprehensive Healthcare & Vitalis Surgical Centre. Please complete all sections of this application. All information is confidential and will be used solely for employment consideration.Personal InformationFirst NameLast NamePreferred Name (if different)Phone NumberEmail AddressAddress Line 1Address Line 2CityState / ProvincePostal CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)RomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweEmergency Contact NameRelationship Phone NumberPosition Applied For Operating Room Nurse (RN/LPN) Endoscopy Nurse (RN/LPN) Clinic Nurse (RN/LPN) Operating Room Technician Anesthesia Assistant Clinical Assistant / Physician Assistant Nurse Practitioner Surgical Office Assistant Medical Office Assistant Reception / Front Desk Sterile Processing (MDR) Technician Allied Health Professional Operating Room / Health Care Aide OtherDepartment Of interest Operating Room (OR) Recovery / PACU Clinic / Outpatient Services Administration Reception / Patient Services Sterile Processing Facility Support ServicesAvailability & Work PreferencesAvailability to StartEmployment Type Desired- Select -Full TimePart TimeTermCasualIndeterminatePreferred Days Available Monday 07:30 - 15:30 Monday 08:00 - 16:00 Monday 12:00 - 20:00 Tuesday 07:30 - 15:30 Tuesday 08:00 - 16:00 Tuesday 12:00 - 20:00 Wednesday 07:30 - 15:30 Wednesday 08:00 - 16:00 Wednesday 12:00 - 20:00 Thursday 07:30 - 15:30 Thursday 08:00 - 16:00 Thursday 12:00 - 20:00 Friday 07:30 - 15:30 Friday 08:00 - 16:00 Friday 12:00 - 20:00 Saturday 07:30 - 15:30 Saturday 08:00 - 16:00 Saturday 12:00 - 20:00 Sunday 07:30 - 15:30 Sunday 08:00 - 16:00 Sunday 12:00 - 20:00 OtherAbility to Work Extended Hours if Required Yes NoReliable Transportation Yes NoCompensation Expectations Expected Hourly Wage or Salary Range Open to Discussing Compensation Based on Experience and QualificationsHourly Wage or Salary RangeEducation & CredentialsHighest Level of Education Completed- Select -High School Diploma (Grade 12)Health Care Aide CertificatePost-Secondary Certificate (Medical / Healthcare Field)Diploma – Practical Nursing (LPN)Diploma – Medical Office Assistant / Unit ClerkDiploma – Surgical / Operating Room TechnicianDiploma – Sterile Processing (MDR Technician)Diploma – Allied Health ProgramAdvanced Diploma – Healthcare FieldBachelor’s Degree – Nursing (BN / BScN)Bachelor’s Degree – Health Sciences / Allied HealthBachelor’s Degree – Other FieldPost-Graduate Certificate – Healthcare SpecializationMaster’s Degree – Nursing (MN / NP)Master’s Degree – Health Sciences / Physician AssistantDoctoral Degree (MD / PhD / Equivalent)International Medical Graduate (IMG Institution(s) Attended Institution Year Degree / Diploma earned Professional Designations / Certifications Certification Expiry Date Licensing Body & ProvinceCurrent License StatusHealthcare & Surgical ExperienceTotal Years of Healthcare Experience Employer(s) Starting from most recent one Employer Name Start Date End Date Brief Description of Duties and ExperienceSkills & Competencies Patient Intake & Registration Patient Care & Monitoring Operating Room Assisting Patient Booking & Coordination Sterile Processing / Infection Prevention & Control Endoscopy EMR / EHR Systems Used Medical Billing & Referrals Patient Education Front Desk / Reception Duties Patient Transport Facility Management Languages Additional Skills or QualificationsLanguagesEmployment Eligibility & Compliance Healthcare Immunization & Screening Requirements Legally Entitled to Work in Canada Criminal Record Check Consent Adult Abuse Registry Check Consent Child Abuse Registry Check Consent Vulnerable Sector Check Consent Professional Liability Coverage Information Physical Ability to Meet Job RequirementsReferencesTwo Professional References, including Name, Title, Organization, Phone, and Email References Name Title Organization Email Phone AttachmentsResumeChoose File Cover LetterChoose File Certifications / LicensesChoose File Applicant Declaration & ConsentCompletion of this application does not guarantee employment or an interview Consent to verify credentials, licenses, education, employment history and references Consent to electronic communication regarding recruitmentEquity, Diversity & Inclusion StatementVitalis Surgical Centre is committed to fostering a diverse, inclusive, and respectful workplace. Accommodation is available throughout the recruitment and selection process in accordance with applicable laws.Signature (Typed Full Name):DateSubmit Form
