Hiring Application Form

First Name

Last Name

Date of Birth

Phone Number

Social Insurance Number (SIN)

City

Province

Postal Code

Position / Designation Select a position Registered Practical Nurse (RPN) Licensed Practical Nurse (LPN) Health Care Aides (HCAs) Registered Nurse (RN)

Available Start Date

Licensing/Registration Number

Province of Registration

Expiry Date

Preferred Employment Type

Full-Time Part-Time Casual

Preferred Shift(s)

Days Evenings Nights

Are you legally eligible to work in Canada?

Yes No

Years of Healthcare Experience

Areas of Experience

LTC/PCH ER Med/Surg OBS Dialysis ICU

Please list your general availability (days/times)

Please share why you are interested in working with Happy Nursing Service.

Resume / CV

Adult Abuse Registry Check *

Child Abuse Registry Check *

Criminal Record Check / Police Check *