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Application Form
Christian Horizon's Host Family Support Services
VON Oxford's Special Services at Home

Position
I am applying for:
 Support Worker   Host Family  (If applying for Host Family, also complete the last page of this application.)

Personal Information
Name Surname: Firstname: Initial:
Address Street: City / Town: Postal Code:
Telephone Home: Business:

Employment History
Are you currently employed?:
 Yes   No If yes, please describe your job.
Name of Employer:
Duties & Responsibilities:
Address1:
  
Address2:
  

Have you been previously employed? Yes No
Name of Employer:
Address1:
Address2:
Telephone:
Duties & Responsibilities:
May we contact you for a reference? Yes No
If yes, please describe your last jobs.
Name of Employer:
Address1:
Address2:
Telephone:
Duties & Responsibilities:
May we contact you for a reference? Yes No

Educational History
Are you currently enrolled in an educational course or program?
 Yes No
  If yes, please describe the course or program.
If no, what was the last grade or course completed?
Name of School:
Program:
Last Grade or Course Completed:
Do you have First Aid training?:
 Yes No
Do you have current C.P.R. training?:
 Yes No
Please describe any other relevant courses.

Volunteer, Community Work or Other Experience
Have you done any volunteer, community work or any other relative experience?:
 Yes No
  If yes, please describe

General Information
Recreation and Leisure: please describe your hobbies, interests, clubs and sports involvement
Briefly explain your interest in being involved with this program.
Would you prefer working with Children Adults or both?
Do you have a valid driver's licence and use of a vehicle? Yes No
Availability of Work
During the week:
Weekends:
Mornings:
Afternoons:
Evenings:

References
Please list 3 references, including one professional person (eg. minister/priest, social worker, employer, not including relatives) that you have known for at least 2 years.
*It is imperative to include FULL addresses and postal codes
Name
Address
Phone Number
 
Street
City
Postal Code
  

Application for Host Family Support Services(not necessary for Support Worker position)
Tell us about the members of your family.
My spouse's name is:
  
Their occupation is:
  
Name
Date of Birth (MM/DD/YYYY)
Your Relationship to Them
     
Do you have any children who live away from home?:
 Yes No  
What language is spoken in the house?:
  
What other languages are spoken?:
  
Are there pets in the house?:
 Cat Dog Others  
Please describe:
  
Please describe your family routine on weekends:

Please Attach Your Resume:  

  
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