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Field Placement Form

Click or drag a file to this area to upload.
Do you speak any languages other than English?
Do you have a current valid non-restrictive Alberta driver’s license?
Do you have a current (in the last 3 months) Criminal Record Check via the Calgary Police Services?

Please read before signing:

I understand the following: · As a condition of placement at CJHS, we require the successful candidate to be fully vaccinated against COVID-19. Where the candidate has not obtained the vaccine, the candidate will be considered on an exceptional, and case by case basis; CJHS will adhere with its obligations under the Alberta Human Rights Act. · Any of the information that I have provided may be verified, and I give permission to CJHS to check my references and to make inquiry of others, including my employer, concerning my background and suitability to act as a volunteer. Reference checks are made to ensure a reliable and equitable review of all prospective practicum students as an important part of the selection process and will be conducted on all candidates who have been interviewed and considered for service with the Society. Offer of service shall not be made contingent solely upon favourable checks; experience and other qualifications will also be taken into consideration. · While in a practicum for CJHS, I will be dealing with confidential information and I agree to keep said information in the strictest confidence; · The relationship between CJHS practicums is an ‘at will’ arrangement, and that it may be terminated at any time without cause by either the student or the agency; · I grant CJHS permission to use my likeness, voice and words in television, radio, film or in any form to promote activities of the agency; · I understand that my attendance and participation as a practicum student may involve risks of injury to which I will be exposed; · I hereby agree to release, discharge and hold harmless CJHS, its officers, agents, its directors and employees of and from all causes, liabilities, damages, claims or demands because of any injury or accident arising out of my attendance and participation in a practicum within the agency; · I acknowledge that I am in good physical condition and that I am unaware of any existing medical condition(s) which would prevent me from participating with CJHS;