EMPLOYMENT APPLICATION FORM

IMPORTANT: Please read the following instructions before completing this application form.

1. The information on this form is being collected to process your application for employment in accordance with the Freedom of Information and Privacy Act under the authority of the Municipal Act for the purpose of determining your eligibility for employment.

2. When completing this application, please include only information which relates to the position you are applying for (if applicable).

3. You may also submit a resumé with the application form for the position you are applying for.

4. Please print when completing the application form.

PERSONAL INFORMATION

Surname: _________________________ First Name: _________________________ Middle Name: _____________________

Address: __________________________________________________________________________________________________

(Street Number, Street Name, City, Province & Postal Code)

Home Phone Number: __________________________________ Business Number: ________________________________

(Please remember to list area code) (If applicable, may we contact you at this number?)

Email Address: _____________________________________________________________________________________________

Are you legally entitled to work in Canada? Yes No

TYPE OF WORK/GENERAL INFORMATION

Are you applying for an advertised position? Yes No

If yes, please indicate which position: ______________________________________________________

Warehouse Drivers Clerical Sales

(For Warehouse Only)

Day Shift

Evening Shift

How did you learn about this position? Ad (Please identify newspaper) _______________________________

Courtney’s Other Other

Website Source Website

_______________ ______________________

EDUCATION

	Course/Program/Major Field	Year Completed	Degree/Diploma
High School:
College/Technical Institute:
University:

Additional Courses Taken:

EMPLOYMENT HISTORY

Please list all employers for a minimum of the last ten years, beginning with your most recent experience (unless they have been included in your attached resumé)

Company Name: _______________________________________________ Phone Number: ____________________________

Address: __________________________________________________________________________________________________

(Street Number, Street Name, City, Province & Postal Code)

Supervisor’s Name: __________________________________ Supervisor’s Title: _________________________________

Position Held: _______________________________________ Length of Employment: _____________________________

Reason for Leaving: __________________________________ From (mm/yy): ___________ To (mm/yy): __________

Duties & Responsibilities: _____________________________________________________________________________________

Company Name: _______________________________________________ Phone Number: ____________________________

Address: __________________________________________________________________________________________________

(Street Number, Street Name, City, Province & Postal Code)

Supervisor’s Name: __________________________________ Supervisor’s Title: _________________________________

Position Held: _______________________________________ Length of Employment: _____________________________

Reason for Leaving: __________________________________ From (mm/yy): ___________ To (mm/yy): __________

Duties & Responsibilities: _____________________________________________________________________________________

Company Name: _______________________________________________ Phone Number: ____________________________

Address: __________________________________________________________________________________________________

(Street Number, Street Name, City, Province & Postal Code)

Supervisor’s Name: __________________________________ Supervisor’s Title: _________________________________

Position Held: _______________________________________ Length of Employment: _____________________________

Reason for Leaving: __________________________________ From (mm/yy): ___________ To (mm/yy): __________

Duties & Responsibilities: _____________________________________________________________________________________

REFERENCES

Name: ____________________________ Relationship: ________________________ Phone Number: __________________

Name: ____________________________ Relationship: ________________________ Phone Number: __________________

Name: ____________________________ Relationship: ________________________ Phone Number: __________________

Applicant’s Declaration and Permission to Obtain References

1. I certify that the information provided in this application and supporting materials provided by me is true and complete.

2. I understand:

a. that my signature on this form is my permission to contact my present/past employers to obtain references

b. that there may be a probationary work period during which my performance and suitability for the position will be reviewed

c. that I may be required to complete a functional abilities exam and/or a criminal records search

d. that if required, I will provide proof of education, certificates, licences and current driver’s abstract.

_____________________________________ _________________________________ _____________________

Applicant’s Signature Please Print Name Date