Independent Contractor Application

Independent Contractor Application
Thank you for your interest in joining our team of independent contractors! Please not that by pressing the 'submit' button, you consent to share this information with Community Support Connections.
Date*

MonthDayYear
Title

Mr.Mrs.MissMs.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
*FULL ADDRESS with POSTAL CODE is required to verify availability of nearby client homes as part of our standard recruitment selection process.
E-mail
Home Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
I Currently Reside in

CambridgeKitchenerNorth DumfriesI live in Waterloo but will work in KitchenerI live outside the region but will commute using my own vehicle
Preferred Areas of Work

KitchenerCambridgeNorth Dumfries
Indicate the Amount of Work Wanted*

Occasional0-6 Hours Weekly6-19 Hours Weekly20-25 Hours Weekly26-40 Hours Weekly
Primary Mode of Transportation*

BusWalkOwn my own vehicleRely on rides provided by family/friends
Age Verification

I am 19 years Old or OlderI am 19 years of age or Older but still attending School/College/UniversityI am a minor.
Education Background

Completed High SchoolCurrently a College or University StudentCompleted University
Personal Support Worker (PSW) Certification

I am a certified personal support worker (PSW)I am currently enrolled in a PSW programI am an activemember of the Ontario Personal Support Worker Association (OPSWA)I have previous experience in PSW, HSW, or home cleaning work
Previous Work Experience

Type out your answers below.
Employer Name
Job Description
Work Period (Start and End Dates)
Contact Information (Phone or E-mail)
Present Work Experience

Type out your answers below.
Employer Name
Job Description
Work Period (Start and End Dates)
Contact Information (Phone or E-mail)
Current Employment Status
Available to Work:*

MorningsAfternoonsBoth
What is your specific availability, dates & times.
Available for:*

HomemakingHome Maintenance & RepairsYard WorkGarden MaintenanceSewingSnow Removal
If you are available for Yard Work, what equipment do you have access to? (Select all that apply.)

Grass Cutting Equipment (Lawnmower, rake, etc.)Garden Maintenance Equipment (Trimmers, clippers, shovel, spade, etc.)No Equipment (Will have to use client-provided equipment)
If you are available for Snow Removal, what equipment do you have access to? (Select all that apply.)

Snow Removal Equipment (Shovel)High-Capacity Snow Removal Equipment (Snow blower, plow)No Equipment (Will have to use client-provided equipment)
Are you eligible to work in Canada?*
I am available to begin work:*
Previous homemaking/home maintenance experience:*
Previous volunteer experience:*
Hobbies and interests:*
Present Occupation:*
Are you a smoker?*

YesNo
Are you comfortable working in a smoking environment?*

YesNo
Are you comfortable working around pets?*

YesNo
Do you have any allergies or health concerns, or are in need of any physical accommodations?*
Do you speak, understand, and write in English fluently?*

YesNo
Do you speak, understand, and write any other languages? If so, please specify:*
I have no concerns about obtaining a clear VULNERABLE SECTOR POLICE CHECK (VSPC) as required by law.

I agree
How did you hear about Community Support Connections?*

Family/FriendSocial MediaIndeedVolunteer Action CentreUniversity/CollegeUnited WayPoster/BrochureNewspaper/Radio/TelevisionCommunity Knowledge/Other AgencyReligious OrganizationKijiji PostingNetworking/Volunteer FairCorporate VolunteerCommunity Support Connections EmployeeCommunity Support Connections Independent ContractorCommunity Support Connections Volunteer
Emergency Contact*

First NameLast Name
Emergency Contact's Phone Number*

Area CodePhone Number
Emergency Contact's E-mail
Relationship of Emergency Contact*
Personal References do not have to be employers. They can be friends, roommates, classmates, or co-workers BUT they cannot be family-related.
Reference #1*
Nature of relationship:*
Reference #1 Phone Number*

Area CodePhone Number
Reference #1 E-mail
*MANDATORY FIELD
Reference #2*
Description:*
Reference #2 Phone Number*

Area CodePhone Number
Reference #2 E-mail
*MANDATORY FIELD
Reference #3*
Description:*
Reference #3 Phone Number*

Area CodePhone Number
Reference #3 E-mail
*MANDATORY FIELD
Why do you want to work with Community Support Connections? Briefly describe your background, talents & ambitions.
Upload CV or Certification here

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Upload Resume here

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Resumes are not a substitution for our Online Screening Process. ALL WEBSITE APPLICATIONS must be completed fully to be considered — Incomplete Applications will not be reviewed. Cancelof
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Independent Contractor Application

Previous Work Experience

Present Work Experience