Seniors Links Student Application Form

Your Name (required)

Your Email (required)

Street Number (required):

City (required):

Postal Code (required):

Phone Number (required):

Gender:
 Male Female

Student ID #:

Name of College/ University you are attending:

Current Program Enrolled In:


 Full Time Part Time Other

Do you have a current criminal record check? (A criminal record check is a definate asset, but is not required at this time).
 Yes No

Criminal record check expiry date:

What kind of work would you willing to do for a senior?:
 Light Housework Shopping Laundry Pet Care Gardening Yard Work Odd Jobs Computer Help Reading Aloud Other

Skills that you feel would be useful to this job:

Training certificates/licenses you hold:

Languages Spoken::

What days and hours are you available to work?

How long are you able to commit to this program?

Other Information you feel would be useful:

Please enter the above letters and/or numbers in the box below: