Centre for Independent Living in Toronto (C.I.L.T.) Inc.
HOME
CONTACT US
DISCLAIMER
LOGIN / REGISTER
LOG OUT
Attendants - Registration & Post My Profile
NOTES:
Fill in the following information that you want to be displayed on the website.
Fields marked with * are compulsory.
Fields marked with RED will NOT be displayed on the website.
Your profile will be posted after it is approved by the CAR administrator
Please remember your "User Name" and "Password", which are used for login.
If you forget your password, the CAR administrator will email you the password upon request. Please provide the following information matching the information that you have provided during registration - first name, last name, user name and email address.
If you do not want your information be posted on the website, check "Do NOT post my profile".
Date Registerd:
Date Updated:
(month/day/year)
Post my profile
Do NOT post my profile
Personal Information:
First Name:
*
Address:
*
Last Name:
*
Apt No:
Gender:
*
Male
Female
City:
*
Email Address:
*
Province:
*
Login Information
User Name:
*
Password:
*
Enter Password again:
*
Postal Code:
Home Telephone:
*
-
Work Telephone:
-
Ext:
Main Intersection:
References
*
(Your must provide the names and phones numbers/email addresses of two consumers you have worked for):
Name:
Telephone or Email Address:
Name:
Telephone or Email Address:
Type of Work
(check all that apply)
:
Regular
Part-Time
Occasional
Travel
Time
(check all that apply)
:
Morning
Afternoon
Evening
Overnight
Areas available to work in
(check all that apply)
:
Ajax
Burlington
Bracebridge
Gravenhurst
Guelph
Hamilton
Huntsville
Kenora
Kingston
Kitchener/Waterloo
London
Markham
Mississauga
Newmarket
Nipissing
North Bay
Oakville
Oshawa
Ottawa
Parry Sound
Peterborough
Pickering
Sarnia
Sudbury
Thunder Bay
Toronto - Downtown
Toronto - East York
Toronto - Etobicoke
Toronto - North York
Toronto - Scarborough
Toronto - York
Windsor
Woodbridge
Others:
Experience with the following disabilities
(check all that apply)
:
ALS
Cerebral Palsy
Multiple Scerlosis
Muscular Dystrophy
Non Verbal
Spinal Cord Injury
Others:
Services provided
(check all that apply)
:
Meal Preparation
Eating Assistance
Lift Devices
One Person Lift
Other transfers
Bathing/Grooming
Ventilators
Bowel/Bladder Care
Catheterization
Nurturing Assistance
Overnight Travelling
Shopping
Housekeeping
Communication Aids
Others:
Skills & Others:
Speak the following languages:
Have a valid Driver's Licence:
Yes
No
Have the following allergies:
Comments & Extra information
(Examples: Training, certificates, relevant experiences)
:
Agreement
*
By checking this box, I AGREE to the following:
1. This Form is NOT an employment application with the Centre for Independent Living in Toronto (CILT) Inc
2. This information WILL be available to interested people with disabilities through this website
3. Payment is the responsibility of the consumer and myself
4. I am willing and able to take direction from consumers
*
I affirm that I have read and agree to CILT's
Disclaimer, Terms of Use and Privacy Policy
.
Copyright ©2004 CILT Inc. All Rights Reserved.
