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CSCL's ShareVision Home Page > Surveys  > New Survey

New Survey: Application Practicum Student


 
Year
Date of Application *
Select a date from the calendar.
First Name *
Last Name *
Email Address
Home Address
Street Address, City, Postal Code
Mailing Address
Please complete if your mailing address is different then your street address.
Home Phone # *
Cell Phone # *
Header - Practicum Information
Header Section - #95B3D7
School/ Institution
School Location
Program/ Area of Study
Type of Program
   
Contact Information
Contact Name for instructor or practicum coordinator.
Contact Phone #
Contact number for instructor or practicum coordinator.
Contact Email
Contact email for instructor or practicum coordinator.
Practicum Start Date
Select a date from the calendar.
Practicum End Date
Select a date from the calendar.
Practicum Hours- Total
What iare the total hours of this practicum?
Practicum Hours/ Week
What are the number of hours per week for this practicum?
Placement
If you are applying for placement in a particular CSCL Program, please specify the name of program(s).
Availability
Are there any days/times when you are unable to complete practicum hours?
Availability Comments
Header - Additional Information
Header Section - #95B3D7
Allergies
Please list any allergies you have (i.e. pets, food) and any limitations you may have relating to them.
Relatives
If you have any relatives currently employed at CSCL, please tell us who.
Relatives .
If you have any relatives receiving service from CSCL, please indicate who are they and what program they are in.
Criminal Record Check
If you are applying to do your practicum with adults: If a Criminal Record Check has already been obtained through school course/ program, the student may provide a copy of recent clearance letter Check must be obtained through the Ministry of Public Safety and Solicitor General Crimminal Records Review Program (CRRP) To obtain a Criminal Record Check, students must complete the Consent to a Criminal Record Check form available from CSCL. Once completed, submit form to the CSCL HR Department who will contact the Ministry of Public Safety and obtain the check. The CRRP is free of charge for practicum students If you are applying to do your practicum with Children/Youth: Criminal Record Check must be obtained through your local RCMP office free of charge for practicum students. Please contact CSCL HR Department for instructions.
Confidentiality Oath *
All matters and information pertaining to individuals that has been gained with the organization must be treated as confidential. Under no circumstances may an individuals information be divulged either inside or outside the organization other then to persons authorized to receive such information in the course of their duties. **By typing your name in the space above, you are stating that you have read and reviewed the above CSCL Confidentiality Oath and that you understand that all individuals information to which you may have access is confidential and is not to be communicated except as outlined in the confidentiality oath.
Declaration *
**By typing your name in the space above, you certify that all information in this application is true and complete. You understand that if any such information is at any time found to be false, such information may be cause for discharge or refusal of practicum placement.
Additional Comments
Please click "OK" to submit your application.
Header - Office Use
Header Section - #95B3D7
Practicum Placement
What site/ program will this practicum student be placed at?
Manager
Who will be the manager responsible for this practicum student?
CRRP Clearance
Has the CRRP clearance letter been received? If no, please comment below.
CRRP comments
RCMP Clearance
Has the RCMP clearance been received? If no, please comment below.
RCMP Comments
HR Comments.
View *