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Application For Employment.

Availablility: Weekdays Weekends Evenings  
First Name: Last Name:
Address: City:
Province: Postal Code:
Phone: Email:
Date of Birth: Gender: Male Female
SIN #:    
Do you have use of an insured vehicle?:YesNo Do you have a valid driver's license?:YesNo
Have you ever worked for an employment agency before? YesNo
If so, which companies?:
Where were you assigned to work?:
Name of Business Type of Work
If you have experience in any of the following trade, please indicate in the space below:
Trade   Years Experience   Trade   Years Experience
Forklift Operator     Furniture Mover  
Shipping/Receiving/Inventory     Machine Shop  
Printing Shop     House Cleaning  
Recycling     Assembly/Manufacturing  
Food Processing     Janitorial  
Heavy Equipment Operator     Fish Plant/Dock  
Landscaping     Swamping  
Occupational First Aid     Carpentry  
         
Are you available for General Labour as well? YesNo
Safety Training Equipment List
WHMIS
Yes No | Expiry:
Reflective Vest YesNo
H2S
Yes No | Expiry:
Steel Toed Boots YesNo
Confined Space
Yes No | Expiry:
Steel Toed Rubber Boots YesNo
Transportation of Dangerous Goods
Yes No | Expiry:
Hard Hat YesNo
OFA Level
Yes No | Expiry:
Safety Glasses YesNo
CPR
Yes No | Expiry:
Work Gloves YesNo
Forklift Certificate
Yes No | Expiry:
Coveralls YesNo
Food Safe
Yes No | Expiry:
Fire Retardants Coveralls YesNo
Other
Other
Safety Issues
Have you ever submitted a WCB Claim? YesNo
Do you have a history of Back Problems? YesNo
Do you have any concerns about working with heights? YesNo
Do you have any concerns about lifting heavy weights? YesNo
Do you have any concerns about working with chemicals? YesNo;
Other medical concerns:
Work References:    
Company: Phone:
Supervisor: Address:
Job: Date:
Reason for leaving:
Company: Phone:
Supervisor: Address:
Job: Date:
Reason for leaving:
Do you have a criminal record? YesNo    
Have you ever had a criminal record check done? YesNo When?

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OR OMISSIONS OF FACT IS CAUSE FOR DISMISSAL. FUTHER, I UNDERSTAND AND AGREE THAT MY EMPLOYMENT IS NOT NECESSARILY FOR A DEFINITE PERIOD.

By typing my name and the date below, I agree to the above terms.

Name: Date: