Ontario Health Staffing for Urgent Needs

Staff member information and availability

Please enter information and availability for one staff member per submission.

When you are done, you will be prompted to return to this page if you wish to submit more staff member information.

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* 1. Staff Member information

First Name

Last Name

Current position in organization

Staff e-mail address

Organization name

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* 2. OH region

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* 3. Work availability (select all that apply)

PSW-type work in LTC

PSW-type work in Retirement Homes

Administrative work in LTC (ie answering phones, delivering meals)

Other as needed

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* 4. Start date

Please enter the date the staff member would be available

Date

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* 5. Shift Availability (select all that apply)

Morning

Afternoon

Evening

Ontario Health Staffing for Urgent Needs

Staff member information and availability

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* 1. Staff Member information

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* 2. OH region

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* 3. Work availability (select all that apply)

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* 4. Start date

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* 5. Shift Availability (select all that apply)

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* 6. How many days per week (in total) will this staff member be available?

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* 7. How many weeks (in total) will this staff member be available for?

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* 8. Contact name for submission (if different from above)

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* 9. Contact e-mail for submission (if different from above)

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* 10. Comments