Job Opportunities

Personal Information

Full Name:
E-mail:
SIN Number:
Phone Number:
Birthdate:

Street Address
City:
Province:
Canada:
Postal Code:

Who referred you to us?
Are you related to a current employee?
If yes, what is the employees full name?
Do you have your own transportation?

Physical Record

Height:
Physical Fitness:

Impairment in: (check any that apply)
Hearing	Vision	Speech

Have you ever missed work due to illness or injury?
If yes, explain:

Employment Desired

Position:
Start Date
Salary Desired

Term:
Time:

Are you Employed Now?
If so, who is your employer?
Have you applied here before?
If so, when did you apply?

Education

	Name of School	Years	Date Graduated	Subjects Studied
High School:
High School:
College:
College:
Additional Education:
Additional Education:

Former Employers

	D/M/Y	Name of Employer	Salary	Position	Reason for Leaving
start date:
end date:
start date:
end date:
start date:
end date:
start date:
end date:

References

Give the names of three people not related to you, whom you have known for at least one year.
	Name	Address	Telephone Number	Years Acquainted
1
2
3

Additional Information:

I understand as a possible future employee for this company, I will be expected to be on time for work each day and not be off excessively due to illness or other problems. Excessive absenteeism will result in dismissal.

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.

I may apply to be included in the company extended benefits plan.