Please briefly list your past work experience:________________________________________
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Please briefly list your related education/course/training (include the last year of education completed):
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Position Applied For: Choose up to three positions by enumeration, i.e., 1 beside first choice, 2 beside
your second choice, and 3 beside your third.

Medical Clinic
[  ] General office support
[  ] Foot care aide
[  ] Foot care support
[  ] Laundry person
[  ] Food planning/preparation for Women's Health Clinic

Kindred House
[  ] Drop-in assistant

Administration
[  ] Casino worker
[  ] Dim Sum with a Difference volunteer
[  ] Envelope stuffer

Community Nursing Station
[  ] General office support

Streetworks
[  ] Needle exchange staff

Board of Directors
[  ] Board member
[  ] Committee member
[  ] Committee chair

Dental Clinic
[  ] Dental hygienist
[  ] RDAII/chairside assistant
[  ] Dentist