Employment Application

Position Applied For:
Expected Wages:
Date Available:

Surname:
Middle Name:
First Name:
Street Address:
City:
Province:
Postal Code:
Telephone:
E-Mail Address:
Are you legally eligible
to work in Canada? 		Yes   No


Education Record

High School:
Diploma awarded? Yes   No

Business/Trade/Tech School:
Subject:
Diploma awarded? Yes   No
Title:

Community College:
Subject:
Diploma awarded? Yes   No
Title:

University:
Subject:
Degree awarded? Yes   No
Title:

Additional Courses, Seminars, Workshops:
Work related skills, experience, or training that is related to the position being applied for:

Employment Record

(Most recent employer first.)

Company Name:
Address:
Type of Business:
From:
To:
Last Salary:
Job title:
Duties/Responsibilities:
Reason for Leaving:
Supervisor:


Company Name:
Address:
Type of Business:
From:
To:
Last Salary:
Job title:
Duties/Responsibilities::
Reason for Leaving:
Supervisor:


Company Name:
Address:
Type of Business:
From:
To:
Last Salary:
Job title:
Duties/Responsibilities:
Reason for Leaving:
Supervisor:


Company Name:
Address:
Type of Business:
From:
To:
Last Salary:
Job title:
Duties/Responsibilities:
Reason for Leaving:
Supervisor:


Have you ever been employed by this company before? Yes   No
If yes, state start and end dates:

What was your position when you left?

May we contact your present employer? Yes   No

What source referred you to this company?

Will you work shift work? Yes   No

Outside hobbies and interests, service clubs or professional associations: (do not list clubs or organizations of a religious, racial, political character)

References

List two persons to whom we may refer (not relatives or previous employers).

Name:
Address:
Telephone:
Occupation:


Name:
Address:
Telephone:
Occupation:

By submitting this form, you are declaring that the foregoing information is true and complete to your knowledge, and understand that a false statement may disqualify you from employment or cause your dismissal.