Personal Information

First Name Last Name

Full Address (address, city, postal code): Phone email

How did you find out about us? newspaper web social network referral

What position are you applying for?

   Hourly wage expectation

When would you be available to start work?

General Information

Do you have a valid driver’s license ?
yes
no
Do you have a current First Aid Certificate?
yes
no

Do you have a WHMIS Certificate?
yes
no
   Are you bondable?
yes
no

Are you capable of lifting up to 75lbs several times a day?
yes
no

Would you be willing to provide a Criminal Record Check?
yes
no

List any job related training you have received

Are you planning on returning to school? yes
no
     If yes, date of return

Education

Highest education received High School University Technical College Other    Area of study/interest:

Certificates/diplomas:

Employment History

Most Recent Job

Title: Length of Employment: Company Name:

Company Address Supervisor

Responsibilities Wage:

Reasons for Leaving

Job 1

Title: Length of Employment: Company Name:

Company Address Supervisor

Responsibilities Wage:

Reasons for Leaving

Job 2

Title: Length of Employment: Company Name:

Company Address Supervisor

Responsibilities Wage:

Reasons for Leaving

Job 3

Title: Length of Employment: Company Name:

Company Address Supervisor

Responsibilities Wage:

Reasons for Leaving

Is there anything else you would like to tell us?

By typing your name below, you are stating that the above information is true and accurate to the best of your knowledge.

Name: Date: