* First Name

* Last Name

* Primary Phone

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* Email Address

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* Address

* City

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* Postal Code

* Are you currently registered with the College of Nurses of Ontario? Select Answer Yes No New Graduate - Working Towards Internationally Trained - Working Towards Registered Out of Province

* If you are currently registered with the College of Nurses of Ontario please provide your registration number. If not, enter N/A

* Has there ever been a complain submitted about your practice, or have you ever undergone an investigation for disciplinary proceeding with the College of Nurses (CNO)? Select Answer Yes No

* Do you have a preferred name?

* Are you a current employee of Muskoka Algonquin Healthcare (MAHC)? If yes, enter your employee number (found on your MAHC paystub). If no, type N/A

* Have you ever been convicted of a crime for which you have not been pardoned for? Select Answer Pardoned/Clean Record I have been convicted but have not yet been pardoned

* Are you able to provide proof of immunization and vaccination? Select Answer Yes No

* Are you eligible to work in Canada? Select Answer Yes Not at this time Working towards

* I confirm that the information I provided including my resume and answers to listed screening questions is factual and up to date. Select Answer Yes No

* Are you able to meet the scheduling requirements as listed on the job posting? Select Answer Yes No

* I understand that this position would require me to work onsite at Muskoka Algonquin Healthcare. Select Answer Yes No

* I understand that applicants must reside within 125km of one of our hospital campuses or be willing to relocate prior to start. *exceptions will be considered on a case-by-case basis Select Answer Yes No

* This position is multi-sited and requires regular work at both the South Muskoka Memorial Hospital (SMMH) located in Bracebridge and Huntsville District Memorial Hospital (HDMH) located in Huntsville. Are you able to meet this requirement? Select Answer Yes No

* This department operates 24/7, which may require a variety of shifts, including days, evenings, nights, weekends, and statutory holidays. Do you understand and are you able to meet this requirement? Select Answer Yes No

* Resume / CV Upload