Personal Information

First Name			Last Name
Street Address

City		Prov		Postal Code
Email Address

Desired Position

Job Applied for		Rate of pay expected
		per
Job Applied for		Rate of pay expected
		per
How did you learn of this opening?
Do you prefer Full or Part Time?
Full Time    Part Time

If part time, specify desired hours:
Have you worked for us before? If so, when?
Yes    No		Dates:
If hired, on what date will you be able to start work?
If hired, do you have reliable means of transportation to get to work?
Yes    No

Are there any other experiences, skills or qualifications, which you feel would especially fit you for work with us? Please exclude activities which would indicate any prohibited grounds of discrimination, listed above.

Training Experience

Do you have a Trade Qualification card or certificate for B.C.? Yes    No

If no, another province (where)?

Training courses taken within the past year: Anything trade related (ICAR, First Aid)

Course		Date Taken

Prior Work History

Employment Dates		Employer		Starting Pay		End Pay		Reason for Leaving

May we contact the employers listed above? Yes    No

APPLICANT’S CERTIFICATION AND AGREEMENT - PLEASE READ CAREFULLY
By submitting this application, I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal.