Please note: denotes a required field

First Name of Employee:
Middle Name(s) of Employee:
Last Name of Employee:
Street Address:
City:
Province/State:
Country:
Postal/Zip Code:
Home Phone:
Business Phone:
E-mail address:
Fax:
Position at The Hospital
for Sick Children:
Department:
Phone # at SickKids:
Department Head:
Administrative Assistant/Coordinator:
Administrative Assistant/Coordinator Phone:
Administrative Assistant/Coordinat e-mail address:
Apartment Preference (Click here for rates)
First Choice:
Second Choice:
Third Choice:
Occupancy Duration
Required from:
Required to:
Other Occupants
Full name:
Relationship:
Full name:
Relationship:
Full name:
Relationship:
Parking
Parking Required?
Make of Car:
License Plate Number:

I authorize The Hospital for Sick Children to carry out any necessary credit and reference checks including
the examination of my personnel file. I have read, understood, and agree with the aformentioned.

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