Applicant Information

Full Name:

Date:

                         Last

First

M.I.

Address:

                         Street Address

Apartment/Unit #

                         City

Province

Postal Code

Phone:

(     )      

E-mail Address:

Date Available:

Social Insurance#:

Desired Salary:

$     

Position Applied for:

Have you ever been convicted of a felony?

YES

NO

If yes, explain:

Education

High School:

Address:

From:

To:

Did you graduate?

YES

NO

Degree:

College:

Address:

From:

To:

Did you graduate?

YES

NO

Degree:

Other:

Address:

From:

To:

Did you graduate?

YES

NO

Degree:

References

Please list three professional references.

Full Name:

Company:

Phone:

(     )      

Address:

Full Name:

Company:

Phone:

(     )      

Address:

Full Name:

Company:

Phone:

(     )      

Address:

Previous Employment

Company:

Phone:

(     )      

Address:

Supervisor:

Job Title:

Starting Salary:

$     

Ending Salary:

$     

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Company:

Phone:

(     )      

Address:

Supervisor:

Job Title:

Starting Salary:

$     

Ending Salary:

$     

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Company:

Phone:

(     )      

Address:

Supervisor:

Job Title:

Starting Salary:

$     

Ending Salary:

$     

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature:

Date: