EMPLOYMENT
					APPLICATION
Applying for: McPhillips □ Regent □ Pembina □ Waverley □ Portage □ No Preference □
Personal Data___________________________________________________________
Name: _____________________________________						SIN: _______-_______-________
Present Address:___________________________________ City: _______________ Prov.: ___________
Postal Code: _______________ Phone: [Home] (_____)______________ [Other] (_____)______________
Drivers License:  [ ] Yes   [ ] No  -  Status:  [ ] Active  [ ] Suspended  [ ] Restrictions; __________________
Education_______________________________________________________________
Check Highest School Year Completed:  [ ] 9,  [ ] 10,  [ ] 11,  [ ] 12,  [ ] other;________________________
Name of School / College / University attended: ________________________________________________
Course(s):___________________________________ Date Completed:_____________________________
Special skills, training, experience, or schooling which may be applicable to our business:______________
______________________________________________________________________________________.
Work Experience_________________________________________________________
Company Name: ______________________________ Address:___________________________________
Job Description: (duties, skills, etc.) _________________________________________________________
_______________________________________________________________________________________
Dates Employed: (start)__________________ (end) __________________  Phone #:__________________
Reason for leaving:_____________________________________ Contact person:_____________________
Work Experience_________________________________________________________
Company Name: ______________________________ Address:___________________________________
Job Description: (duties, skills, etc.) _________________________________________________________
_______________________________________________________________________________________
Dates Employed: (start)__________________ (end) __________________  Phone #:__________________
Reason for leaving:_____________________________________ Contact person:_____________________
Work Experience_________________________________________________________
Company Name: ______________________________ Address:___________________________________
Job Description: (duties, skills, etc.) _________________________________________________________
_______________________________________________________________________________________
Dates Employed: (start)__________________ (end) __________________  Phone #:__________________
Reason for leaving:_____________________________________ Contact person:_____________________
Work Experience_________________________________________________________
Company Name: ______________________________ Address:___________________________________
Job Description: (duties, skills, etc.) _________________________________________________________
_______________________________________________________________________________________
Dates Employed: (start)__________________ (end) __________________  Phone #:__________________
Reason for leaving:_____________________________________ Contact person:_____________________
Additional Information____________________________________________________
Employment Desired:___________________________________ Wage Desired:_____________________
Days/Hours Available:__________________________________ Start Date: _________________________
Volunteer Work: _________________________________________________________________________
Work Experience: _______________________________________________________________________
References_____________________________________________________________
Name:________________________________________________________ Phone:___________________
Name:________________________________________________________ Phone:___________________
Name:________________________________________________________ Phone:___________________
Other__________________________________________________________________
If Hired, I realize that I am on a (1) one month probationary period in which time I may quit or be terminated
without notice. After (1) one month, I must give minimum (2) two weeks written notice.
I authorize investigation of all statements contained in this application and understand that misrepresentation
or omission of facts may be cause for dismissal.
Signature:____________________________________________ Date:______________________________