APPLICATION FOR EMPLOYMENT

      In compliance with Federal and State equal employment opportunity laws, qualified applicants are
considered for all positions without regard to race, colour, religion, sex, national origin, age, ,marital status, or
the presence of a non-job related medical condition or handicap. 
 

    Date:  

      Position(s) applied for:

      Name (Last):

      Name (Middle):

      Name (First):

      Social Insurance No:

      Address:

      City:

      Province:

      Phone:

      Cell:

      Address for the past 3 years

      Street:

      City:

      Province & Postal Code:

      How long?

If you lived at the previous address for less than 3 years, please fill in below section

      Street:

      City:

      Province & Postal Code:

      How long?

      Are you 21 years or more and less than 65  years of age? Please Select yes no  

      Can you provide proof of age?

      In case of emergency notify

      Name (first & last):

      Address:

      Phone:

  Have you worked for this company before?

Dates: From

To

Rate of Pay

Position Held

  Reason for leaving

  Are you now employed?

  If not, how long since leaving last place of  employment?                            

  Who referred you?

  Rate of pay expected:

Physical History

  List any handicap that prevents you from doing certain kinds of work

  Are you physically capable of heavy manual work?   Please Select Yes No

  Ever injured on the job?

  If yes, give the nature and degree of such injuries

 
  How much time lost from work in the past three years for illness?  

  Would you be willing to take a physical examination?                     Please Select Yes No  

  Have you ever?

  Tested positive for a controlled substance?

  Refused a drug test?

  Has a breath alcohol test greater than 0.04 for a company to which you applied but did not work for: Please Select Yes No
 

Employment History

  Please list any accidents of traffic convictions for the past 3 years

Education

  Select the highest grade completed:

  High School:

  College:

  Last school attended:

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School Attended

Program

Grad Date

Driving Experience

Province

License #

Class

Expiry Date

 (A) Have you ever been denied a license, permit or  privilege to operate a motor vehicle? Please Select Yes No  

 (B) Has any license, permit or privilege ever been  suspended or revoked?                         Please Select Yes No  

    
If the answer to either A or B is YES, please provide the details

Training and Qualifications

Please list special training and/or qualifications you have that may be beneficial for this application

Please read and verify the following

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
I authorize you to make such investigations and inquires of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools or personal from all liability in responding to inquires in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulation of the company, as permitted by law.

I agree with these terms and conditions: 

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