* First Name

* Last Name

* Primary Phone

You confirm that the primary phone number entered above is your current mobile number. We may send text messages regarding your application to this number. Message & Data rates may apply. Reply STOP to end.

* Email Address

* Country of residence Choose One Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos [Keeling] Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Côte d’Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau SAR China Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar [Burma] Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Réunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Minor Outlying Islands U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

* Address

* City

* Province/Territory

* 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

* Have you ever undergone an investigation for disciplinary proceedings with the College of Nurses? Select Answer Yes No

* Do you have a preferred name?

* Are you a current employee? Enter your employee number (found on your paystub). If no, type N/A

* If you were referred by a Muskoka Algonquin Healthcare team member please identify them or 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 I have medical accommodation

* 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

* Resume / CV Upload