Please complete this application form if you are interested in a co-op placement at St. Joseph's Health Centre. In order to participate, students must be at least 16 years of age, in Grade 11 or 12 and enrolled in their school’s co-op education program.

Once you complete all the sections, click the 'Continue' button at the bottom to submit this form.

Contact Information

(*indicates mandatory fields)

Teacher Contact

General Information

Employment and Volunteer Experience


Please indicate which semester you will be available for


Areas of placement interest

Please check three (3) opportunities that you are interested in. *PLEASE NOTE THAT NOT ALL OPPORTUNITIES ARE AVAILABLE*

Co-op Questions

1. Why have you requested a placement in a health care facility?


2. How will this placement help you with your career choice?


3. What can you contribute as a Co-op student in this placement?


4. What research have you done to explore this career pathway?

Emergency Contact

THANK YOU for your interest in a co-op placement

I certify that all information in this application form is true and complete. False statements or omissions are grounds to terminate the relationship no matter when they are discovered.

I authorize the Volunteer Services Department staff to contact my references to determine my suitability for a co-op position. If accepted, I understand that prior to starting my co-op position I must complete the required immunization outside of SJHC (including a two-step TB Screening). SJHC cannot be responsible for the Physician charges related to immunization. If over 18 years old, I must consent to a criminal reference check being done. If accepted, I agree to comply with the policies and procedures of St. Joseph’s Health Centre and the Volunteer Services Department as outlined during orientation and training.

I understand that SJHC is committed to protecting the privacy of my personal information in its possession. Personal information in SJHC’s possession will be kept confidential and it will not be sold, traded or loaned to any other organization. The information on this form will be used by SJHC to identify co-op interest and determine suitability for a specific co-op position. The co-op/SJHC relationship can end at any time by either party (this relationship is at will and is not a contract of employment).