OFFICE USE ONLY

    DATE HIRED:

    POSITION:

    EE#:

    DATE:

    POSITION(S) APPLIED FOR (LIST IN ORDER OF PREFERENCE):

    SURNAME:

    GIVEN NAMES:

    NAME GENERALLY KNOWN BY:

    EMAIL ADDRESS:

    RESUME:

    PERSONAL INFORMATION

    ADDRESS

    STREET & NUMBER

    CITY/TOWN

    POSTAL CODE

    SOCIAL INSURANCE NO.

    MAILING ADDRESS IF DIFFERENT FROM ABOVE

    DATE OF BIRTH

    HOME PHONE NUMBER

    HAVE YOU EVER WORKED FOR THIS COMPANY BEFORE?
    IF YES, PLEASE SPECIFY DATES.

    DO YOU HAVE YOUR OWN TRANSPORTATION

    IN CASE OF AN EMERGENCY, WHOM WOULD YOU WISH NOTIFIED

    NAME

    HOME#

    CELL#

    WORK#

    ADDRESS

    NOTE: PAYROLL MUST HAVE PHOTO COPIES OF YOUR VALID CERTIFICATIONS

    HEAD COOKS, 2nd COOKS & BAKERS REQUIRE:**FOOD SAFE CERTIFICATE & 1st AID CERTIFICATE

    CAMPIES REQUIRE:**1ST AID CERTIFICATE

    TICKET

    TICKET NUMBER

    EXPIRY DATE

    FOOD SAFE CERT

    .

    PAPERED CHEF

    OTHER(LIST)

    TICKET

    TICKET NUMBER

    EXPIRY DATE

    FOOD SAFE CERT

    WHMIS

    H2S

    DRIVER'S LICENSE NUMBER AND CLASS

    CONTINUED ON REVERSE

    PREVIOUS EMPLOYMENT

    EMPLOYER

    FROM

    TO

    POSITION

    AREA WORKED

    NUMBER OF YEARS WORKING IN THE FOOD INDUSTRY:

    NUMBER OF YEARS AS A CUSTODIAN/JANITOR:

    MEDICAL HISTORY

    Do You suffer any physical defects???

    • Hearing
      Hearing

    • Epilepsy
      Epilepsy

    • Skin Trouble
      Skin Trouble

    • Silicosis
      Silicosis

    • Rupture
      Rupture

    • Heart Condition
      Heart Condition

    • Back Injury
      Back Injury

    • Vision
      Vision

    • Respiratory
      Respiratory

    Other:

    LIST ACCIDENTS THAT REQUIRED MEDICAL ATTENTION (if any)

    DATE

    TYPE INJURY

    TIME LOST

    EMPLOYER AT THE TIME OF ACCIDENT

    HAVE YOU EVER CLAIMED FOR WORKERS COMPENSATION??? IF YES, EXPLAIN.

    Upon final acceptance of this application, the employee shall enter a formal employment agreement of any applicant upon proof of misrepresentation in the application, upon receipt of unsatisfactory references, upon failure to pass
    any physical examination, upon any evidence of intoxication or impairment when reporting for work or upon any act of dishonesty.

    I certify that all the information in this application is true and complete. If accepted for employment I understand that I am required to abide by all safety regulations regarding clothing and abide by all company policies.

    The job/position for which you are applying is seasonal or is based on a specific project. Section 5(3) and 5(4) of the Alberta Employment Standards Regulation, and Section 55(2) of the Alberta Employment Standards Code authorizes an employer to terminate your employment without further notice or payments in lieu of notice, at:

    (a) the completion of the driling season if your employment contract explicitly specifies this is when your employment ends;

    (b) the completion of the well for which you are being hired; or

    (c) continued employment is or has become impossible for the employer to be perform because of unforeseeable or unpreventable causes beyond his control.

    All information given in this application will be kept strictly confidential.

    Date