Hiring - RSW Part 1 - Employment Application Mobile Social Clinic

Employment Application RSW to Mobile Social Clinic
Please provide your RSW Cert # to confirm that Mobile Social Clinic will be accessing the RSW Online Public Registry on a continuous basis. The Registry allows Mobile Social Clinic to verify the registration of a Practicing member in Manitoba by certificate number. Mobile Social Clinic will access the registry for Hiring Process, Approval for case assignment as a therapist, Update of Annual Review and Renewal to the college. https://mcsw.ca.thentiacloud.net/webs/mcsw/register/
Date Submitted

MonthDayYear
Date
RSW Certification Number
Name

First NameLast Name
Phone Number

CellOther
Email
example@example.com
Desired Hours
Date able to Begin

MonthDayYear
Date
Manitoba College Social Work

Standard 7 Private Practice
Social Workers in private practice are responsible to uphold the MCSW Standards of Practice, and MCSW Code.

Standard 7 Practice Directives should be reviewed and followed in partnership with Mobile Social Clinic or self directed as a practitioner. The following require a response for employment with Mobile Social Clinic.
7.2 Social Workers in private practice will maintain regular consistent and structured supervision from a supervisor with relevant expertise, experience and knowledge of social work ethics and standards of practice.

Yes, I have a supervisor
7.4 Social Workers will ensure professional liability insurance is maintained.

Yes, I have liability insurance
Additional Information
Drivers License *Scanned Submission of Liscence

YesNo
Drivers Licence

Cancelof
Type of Car Insurance (MPI)

BasicBusiness
Employment Choice

In-Home TherapistTalk and WalkVirtual Therapist
Resume

Cancelof
Specialty as a Therapist
Education: List information for all levels completed
Years of work experience (specify in home and In office)
Employment Experience (will be confirmed under RSW Public Registry)
Signature

Clear
Office Use Reviewed by

D.F.C.C.
Office Use Date Reviewed by

MonthDayYear
Date
Office Use Public Registry reviewed

YES
Office Use Practice Limitations

NONE
Office Use Interview Date

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
Office Use Interview Via

ZoomTelephoneIn-person
Office Use Proceed to Part 2 - Interview Questions

YesNo
The RSW certification number verifies that the Member assigned is in good standing with the College. For detailed policy and procedures of the Manitoba College of Social workers RSW, please refer to the "Join the College" https://mcsw.ca/join-the-cillege/
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Employment Application RSW to Mobile Social Clinic

Manitoba College Social Work