employee applicationform
TRANSCRIPT
7/29/2019 Employee Applicationform
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APPLICATION FOR EMPLOYMENT
(ANSWER ALL QUESTIONS)
In compliance with the Federal, State and Provincial equal employment opportunity Laws, qualified
applications are considered for all positions with out regard to race, color, Religion, sex, national origin,age, marital status, or the presence of non job related medical condition or handicap.
Position (s) Applied For Date
Name (First) (Middle) (Last)
Address
City Province/State Postal/Zip Code
S.I.N. Phone Email
(If address above less than 3 years, list previous address below)
How Long? Circle time unit.
Address
Days / Weeks / Years
City Province/State Postal/Zip Code
How Long? Circle time unit.
Address
Days / Weeks / Years
City Province/State Postal/Zip Code
Date of Birth
Can you supply proof of age? Yes No
Health Card Number Marital Status
In case of emergency notify
PERSONAL HISTORY
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Have you worked for this company before?
If Yes Date (From-to) Where?
Rate of Pay Position Reason for Leaving
Are you employed now? Yes No
If not, How long since leaving last employ? Circle Time unit. Days / Weeks / Years
Who referred you? Rate of Pay expected
List any handicap that prevents you from doing certain types of work
Are you physically capable of heavy work? Yes No
Ever injured on the job? Yes No
Give nature, and degree of injuries
How much time lost from work in the past 3 years from illness? Circle time unit.
Days / Weeks / Years
Would you be willing to take a physical examination? Yes No
(Note: List employers in reverse order starting with the most recent.)
Employer Name Date (from-to) Position
Address City
Province/State Postal/Zip Code Phone
PHYSICAL HISTORY
EMPLOYMENT HISTORY
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Employer Name Date (from-to) Position
Address City
Province/State Postal/Zip Code Phone
Employer Name Date (from-to) Position
Address City
Province/State Postal/Zip Code Phone
Highest Grade Completed School Attended City
EDUCATION
EXPERIENCE AND QUALIFICATIONS
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Date Applicant Signature
Please mail this form in confidence to:
Bright-Light Network Solutions
Attention: Human Resources Department
1288 Ritson Road North, Suite 376
Oshawa, Ontario, L1G 8B2
Canada
Employee Application.Doc 2011.12.07
TO BE READ AND AUTHENTICATED BELOW
This certifies that completed this application, and that all entries on it and
information in it are true and completed to the best of my knowledge.
I authorize you to make such investigations and inquiries of my personal,
employment, financial or medical history and other related matters as may benecessary in arriving at an employment decision, I hereby release employers,
schools or persons from all liability in responding to inquiries in connection with
my application.
In the event of employment, I understand that false or misleading information
given in my application or interview(s) may result in discharge. I understand also
that I am required to abide by all rules and regulations of the company, as
permitted by law.