Job Application

Job Application
Must be 21 years or older to apply

Please be aware that forms with missing information WILL NOT be considered If you are selected for an interview, you are required to provide evidence of the below details.

THE INFORMATION YOU SUPPLY ON THIS FORM WILL BE TREATED IN CONFIDENCE.

Address
Address
City
State/Province
Zip/Postal
Driving License
Do you hold a valid driver’s license?
Transportation
Do you have reliable transportation to/from work?
Are you willing to work any shift?
Are you bound by any agreement with any current/former employer?

Emergency Contact

Address
Address
City
State/Province
Zip/Postal

Section 2 Present Employment

(If now unemployed give details of last employer)
Address
Address
City
State/Province
Zip/Postal

Section 3 Previous Employment

Address
Address
City
State/Province
Zip/Postal

Address
Address
City
State/Province
Zip/Postal

Section 4 Education

Qualifications obtained from Schools, Colleges and Universities. Please list highest qualification first:

Skills

Check those skills that you have. List any other skills that may be useful for the job you are seeking. On a scale of 1-5, rate each particular skill. (1= poor ability, while 5 = exceptional ability)

Skill

Rating

Accounting/Bookkeeping
Money Handling
Answering phones
Filing
Customer Service
Specialized Sales Skills/Pitch
Stocking/Cleaning
Multi-tasking
Lift 25+ pounds
Bend/Reach
Tolerate Colder Temps (Stocking Cooler)
Are you able to perform the essential functions of the job position you seek with or without accommodations? (Circle one)

Section 5 Training and Development

Please give details of any training anddevelopment courses or non-qualifications courses which support your application. Include any on the job training as well as formal courses.

Section 6 Health

Successful applicants will be required to complete a detailed medical questionnaire and may be required to attend a medical examination (at the expense of the applicant) prior to being appointed.

Section 7 References

Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your references are. Forms with no referees given WILL NOT be considered.
Reference 1
Address:
Address:
City
State/Province
Zip/Postal
Are you willing for this referee to be contacted prior to or after the interview?

Reference 2
Address:
Address:
City
State/Province
Zip/Postal
Are you willing for this referee to be contacted prior to or after the interview?

Section 8 Declaration

Statement to be Signed by the Applicant

 

Please complete the following declaration and sign it in the appropriate place below. If this declaration is not completed and signed, your application will not be considered.

I hereby certify that:
  • All the information given by me on this form is correct to the best of my knowledge
  • All questions relating to me have been accurately and fully answered
  • I possess all the qualifications which I claim to hold
  • I understand that any omissions or misrepresentations of information on this application form may, in the event of my obtaining employment, result in disciplinary action, up to and including dismissal