Application for Employment

First Name	Middle Initial	Last Name
Present Address
Address
City	Province	Postal Code
Telephone	E-mail
( )

Position	Rate of Expected Pay
	$ PER Hour Day Week Month Year
	$ PER Hour Day Week Month Year
Are you available to work: Full-Time       Part-Time       Temporary       to
How did you learn of this opening?
Have you worked for us before? Yes       No If yes, specify position
If hired, on what date will you be available to start work?
If hired, do you have reliable transportation to get to work? Yes       No
State any other experiences, skills or qualification which you feel are relevant to your application for employment. Please exclude information that would indicate any prohibited grounds of discrimination.

Provide below all information relevant to your educational background. Where appropriate describe: course of study, any honors received, specialized training and apprenticeship skills.

Years Completed	Elementary School					High School					Undergraduate College/University				Graduate / Professional
	4	5	6	7	8	9	10	11	12	13	1	2	3	4	1	2	3	4
Diploma / Degree
Describe Course of Study
Describe any Honors Received
Describe any Specialized Training

Starting with your present job, include any job-related military service assignments and volunteer activities. Please exclude information that would indicate any prohibited grounds of discrimination.

Name of Company or Employer Address Telephone ( ) Email Supervisor's Name

Dates Employed From To January February March April May June July August September October November December 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 January February March April May June July August September October November December 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 Rate of Pay Start Finish

Title/Position Held Reason for Leaving Describe in detail work performed

Name of Company or Employer Address Telephone ( ) Email Supervisor's Name

Dates Employed From To January February March April May June July August September October November December 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 January February March April May June July August September October November December 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 Rate of Pay Start Finish

Title/Position Held Reason for Leaving Describe in detail work performed

Name of Company or Employer Address Telephone ( ) Email Supervisor's Name

Dates Employed From To January February March April May June July August September October November December 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 January February March April May June July August September October November December 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 Rate of Pay Start Finish

Title/Position Held Reason for Leaving Describe in detail work performed

Give the names of at least 3 persons who can supply information pertinent to your job performance, excluding former employers or relatives.

Name	Occupation	Address	Telephone	Email
			( )
			( )
			( )
			( )

To assist us in finding the proper position for you in our company, use the space below to summarize any additional information necessary to describe your skills and qualifications. Please exclude information that would indicate any prohibited grounds of discrimination.

Please Read Carefully

The parties acknowledge that they have required that this application form and all related documents be prepared in English (province of Quebec).

Les parties reconnaissent avoir éxigéque la présente demande d'emploi et tous les documents conexes soient rédigés en anglais.

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.