Quick Contact

L'Arche Daybreak
11339 Yonge Street
Richmond Hill ON, L4S 1L1, CANADA

Phone: (905) 884-3454
Fax: (905) 884-0580
CONFIDENTIAL
APPLICATION
LIVE-IN HOUSE ASSISTANT
 *= Required Field.
A PERSONAL DETAILS
 
Miss.Ms.Mrs.Mr. :
Citizenship :
First/Given Name(s) :  *
Surname/Family Name :  *
Complete Mailing Address
Street :  *
City :  *
Province :  *
Postal Code :  *
Telephone-including area code :  *
Email :  *
Re-Type Email :
Are you 18 years or older :
Have you ever been employed by, volunteered in, or visited a L'Arche community before? :
Year(s)in which I lived in this community :
B RELEVANT INFORMATION
 
How did you hear about L'Arche? :
Why do you wish to come to a L'Arche community? :
How long would you hope to be in L'Arche?
(We give priority to those who can commit for at least one year) :
What are your goals for yourself in comming to L'Arche? :
Have you read the Charter of L'Arche? :
When would you be available to start? :     
C EDUCATION, SPECIAL SKILLS EXPERIENCE
Highest Level of Education Completed :  *
Field of Study :  *
Have you had previous experience living or working with developmental disabilities? :
Please describe any additional education, work, volunteer or life experience that would be relevant to your application as a live-in house assistant :
Do you have current CPR (Cardio Pulmonary Resuscitation) and First Aid Certification? :
Do you have valid driver's licence? :
Number of years of insured driving experience :
How would you describe your ability to speak English? :  *
D HEALTH
Since you will be providing personal care for individuals who are vulnerable, we ask that you please complete the following health questions. If your application is accepted you will be required to obtain a medical review before you arrive.
Alcoholism :
Drug Addiction :
Prescription Drug Abuse :
Personality Disorder :
Epilepsy :
Blackouts :
Diabetes :
Heart Disease :
Limitations with lifting :
If the answer is yes to any of the above, please elaborate :
Do you have any communicable disease? :
If so, please describe :
E REFEREES
Please give details of three referees whom we may contact in connection with your application. At least one referee, and if possible all three, should have known you for more than 3 years. They should not be members of your family
1 This person must have known you for more than 3 years
Title, Initial(s) Family name :  *
Address :  *
Postal Code :  *
Email :  *
Telephone No.(Daytime) :  *
Telephone No.(Evening) :  *
How many years has this person known you? :  *
In what capacity? :  *
2 This person must have known you in a professional capacity (e.g. employer, teacher, supervisor, clergy)
Title, Initial(s) Family name :  *
Address :  *
Postal Code :  *
Email :  *
Telephone No.(Daytime) :  *
Telephone No.(Evening) :  *
How many years has this person known you? :  *
In what capacity? :  *
3 Other Referee (preferably someone who knows you in a professional capacity
Title, Initial(s) Family name :  *
Address :  *
Postal Code :  *
Email :  *
Telephone No.(Daytime) :  *
Telephone No.(Evening) :  *
How many years has this person known you? :  *
In what capacity? :  *
Is there anything else you would like us to know with regard to your application? :
I am also applying to other communities through the L'Arche Canada website :
IMPORTANT NOTE: Please apply only one time. Your application will only be processed in one community at a time and not concurrently. If you are applying on line through the L'Arche Canada website you do not need to contact individual communities.

Applicants should also e-mail your CV or resume to: humanres@larchedaybreak.com
I have read and accept Part F below :
Thank you for applying to be an assistant at L'Arche. Please click the "Submit" button below when you have completed your application.
Please ensure all fields are filled in.
F DECLARATION

I declare that the information given on this form is to the best of my knowledge true and complete. I agree to L'Arche taking up any references in connection with this application and understand that these will be confidential between the referee and L'Arche. I also agree to any Criminal Records Bureau or Police checks which may be required as part of L'Arche's recruitment procedures.

I agree that the information provided in this application form may be processed by L'Arche in relation to my application for this position to assist in the decision making process. I further expressly agree that, should it be necessary to validate any of the information provided therein, L'Arche may release the information for verification purposes. If I am successful in my application, it is agreed that any information provided will be retained by L'Arche in a secure and confidential file, and the contents only used for necessay business purposes, subject to my express consent for disclosure where necessary.

Please note: L'Arche Daybreak will not use or sell your email address or disclose your personal information to third parties without your consent.