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VPI Healthcare Training Application

Full Name

*

Email Address

*

Phone Number

*

What city do you live in?

*

Are you currently registered with VPI Employment Services?

*

A

Yes

B

No

C

Not Sure

What best describes your healthcare background?

*

A

PSW or Home Support Worker training

B

Other healthcare education (including international training)

C

Healthcare or caregiving work experience

D

Both healthcare training and work experience

E

No previous healthcare experience or education

What type of healthcare position are you interested in?

*

Personal Support Worker (PSW)

Home Support Worker

Caregiver

Healthcare Support / Aide

Other

Which skills would you like to strengthen?

*

Practical client care and support

Infection prevention and workplace safety

Safe mobility and transfers

Dementia awareness and client communication

Canadian healthcare workplace expectations

Interview and employment preparation

Are you currently looking for employment in healthcare?

*

A

Yes

B

Planning to soon

C

No

Are you available to attend all three days of training?

*

A

Yes

B

No

C

Not Sure

What is your current status in Canada?

*

A

Canadian Citizen

B

Permanent Resident

C

Convention Refugee / Protected Person

D

Refugee Claimant

E

Work Permit Holder

F

Study Permit Holder

G

Visitor

H

Other / Not Sure

What languages do you speak?

*

English

French

Hindi

Punjabi

Urdu

Arabic

Tamil

Mandarin / Cantonese

Tagalog

Spanish

Farsi

Other (please specify)

Do you consider yourself an English as a Second Language (ESL) learner?

*

A

Yes

B

No

C

Not Sure

How would you describe your English communication skills?

*

A

Beginner – I understand and speak basic English but need support.

B

Intermediate – I can communicate in English but sometimes need clarification.

C

Advanced – I can communicate comfortably in most situations.

D

Fluent – I can communicate confidently in English.

Final Consent Checkbox

*

I understand that completing this form does not guarantee participation in the program. I consent to VPI Employment Services contacting me regarding my pre-screening and next steps.