ࡱ> +5749:;<=>?@ABCDEFGHIJKLMNOPQRSTU_Z\%` bjbjNN V,,|$,,,P,-CH-----...6666LQ6<qC$8FhHhC1..11C--C/3/3/31|--6/316/3/3/3-- `ֆ,g2j/3O3C0C/3I2I/3I/3 .e/h/3/T!0...CC2^...C1111$2$d2$ Return: attention: "Community Support" to address below: EMBED CorelPhotoPaint.Image.8  2 MacNeil Court Kanata, K2L 4H7 591-3686 Community Support Program HOME HELP APPLICATION (Independent Worker) Western Ottawa Community Resource Centre NAME: ADDRESS: PHONE: _________________________________________________ _________________________________________________ _________________________________________________ ___________________ FAX/EMAIL: ___________________Are you eligible to work in Canada? YES NOLanguage(s) Spoken: ___________________________________________Please circle in which area you are willing to work: Goulbourn Kanata West CarletonTransportation: (please circle) drive own car/vehicle use public transportationWill you work in a home where the client smokes? Will you work in a home where there are animals present?YES YESNO NOWhen are you available to work? (please circle) weekdays weekendsType of work you are willing to do: ( Meal preparation ( General housecleaning ( Heavy spring cleaning ( Laundry other: _______________________________________________________ Do you have any specialties/other type of work you will be willing to do? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ EMPLOYMENT EXPERIENCE / REFERENCE (most recent employer first)COMPANY: CONTACT: ADDRESS: _________________________________________________ ________________________ PHONE: ________________ _________________________________________________LENGTH OF EMPLOYMENT: ________________ to ________________JOB TITLE/POSITION: REASON FOR LEAVING: _____________________________________ _____________________________________COMPANY: CONTACT: ADDRESS: _________________________________________________ ________________________ PHONE: ________________ _________________________________________________LENGTH OF EMPLOYMENT: ________________ to ________________JOB TITLE/POSITION: REASON FOR LEAVING: _____________________________________ _____________________________________COMPANY: CONTACT: ADDRESS: _________________________________________________ ________________________ PHONE: ________________ _________________________________________________LENGTH OF EMPLOYMENT: ________________ to ________________JOB TITLE/POSITION: REASON FOR LEAVING: _____________________________________ _____________________________________CHARACTER REFERENCE (no family or close friends. Must have known you for at least 12 months.)NAME: ADDRESS: _________________________ PHONE: ________________ _________________________________________________RELATIONSHIP TO YOU:  _____________________________________NAME: ADDRESS: _________________________ PHONE: ________________ _________________________________________________RELATIONSHIP TO YOU:  _____________________________________NAME: ADDRESS: _________________________ PHONE: ________________ _________________________________________________RELATIONSHIP TO YOU:  _____________________________________EMERGENCY CONTACT: NAME: ____________________________ PHONE: _________________I acknowledge that the information given is true and correct to the best of my abilities. 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