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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.
*
1.
Staff Member information
(Required.)
First Name
Last Name
Current position in organization
Staff e-mail address
Organization name
2.
OH region
North
West
Central
East
Toronto
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
4.
Start date
Please enter the date the staff member would be available
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
5.
Shift Availability (select all that apply)
Morning
Afternoon
Evening
6.
How many days per week (in total) will this staff member be available?
1 day/week
2 days/week
3 days/week
4 days/week
5 days/week
6 days/week
7 days/week
7.
How many weeks (in total) will this staff member be available for?
1 week
2 weeks
3 weeks
4 weeks
5 weeks
6 weeks
7 weeks
8 weeks
8.
Contact name for submission (if different from above)
9.
Contact e-mail for submission (if different from above)
10.
Comments
