Employer name Dates (MM/YY - MM/YY) Social service related? (Y/N) Paid/Volunteer
Name:
Phone: Email:
1. Have you ever applied to the Social Service Worker program before?
Have you applied for admission to any other Social Service Worker program?
2. Are you presently employed?
3. Previous Employment: List in chronological order (beginning with most recent) the dates of employment, name of employer,
and type of work.
Can we have your permission to contact your employer or any previous employer for a reference, if we wish?
STUDENT INFORMATION
Social Service Worker Program
SUPPLEMENTAL APPLICATION
Additional information required for application to the Social Service Worker program.
To be completed in addition to the general Langara College Application Form.
Yes
Yes
Yes
Yes
No
No
No
No
If so, in what year?
If yes, where? Employer:
Length of employment:
Type of work:
If yes, state which colleges and the years of application.
Date (YYYY/MM/DD):Langara ID:
4. Have you done any volunteer work in the social services and/or health fields? If so, please state where, when, and the kind
of volunteer work you were doing.
5. What makes you interested in taking this program? How far back does this interest go?
6. What kind of things would you hope to find yourself doing as a social service worker aer you have completed this
program?
7. The Social Service Worker program is a very demanding full-time course of study requiring aendance at classes and
practicum placements from 8:30 am to 4:30 pm Monday to Friday, plus reading and assignments in the evenings and on
weekends.
Are you prepared to commit to fulfilling these requirements?
8. Please provide a telephone number of a relative or friend who may know your whereabouts in case we cannot reach you to
arrange an appointment.
If you are a student with a disability and require accommodations, please contact Acessibility Services to schedule an
appointment. Please visit hps://langara.ca/student-services/accessibility-services/index.html for information and important
deadlines.
Yes No I would like to discuss this with a member of the program faculty.
Name:
Phone:
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