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* 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 currently registered with the College of Respiratory Therapists of Ontario? Select Answer Yes No New Graduate - Working Towards Internationally Trained -Working Towards Registered Out of Provence

* If you are currently registered with the College of Respiratory Therapists 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 Respiratory Therapists of Ontario? 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. Select Answer Yes No

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* Referrer's First Name

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Referrer's Email Address

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