Appendix D – Sample application for employment

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Position being applied for_____________________________Date available to begin work__________________

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PERSONAL DATA
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Last name____________________________________Given name(s)__________________________________

Address_____________________________Street_____Apt. No. _____Home Telephone Number____________

City____________________Province________Postal Code_______Business Telephone Number____________

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Are you legally eligible to work in Canada? ◻ Yes ◻ No
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Are you 18 years or more? ◻ Yes ◻ No
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Are you willing to relocate in Ontario? ◻ Yes ◻ No
Preferred Location____________________________

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To determine your qualification for employment, please provide below and on the reverse, information about your academic and other achievements including volunteer work, as well as employment history. Attach any additional information on a separate sheet.
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EDUCATION
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◻ SECONDARY SCHOOL
◻ BUSINESS OR TRADE SCHOOL

Highest grade or level completed_______________Name of program___________________________________
Length of program___________________________

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Licence, certificate or diploma awarded? ◻ Yes ◻ No
Type:________________________________________

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COMMUNITY COLLEGE ◻ UNIVERSITY ◻
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Name of Program___________________________Length of Program______
Diploma/Degree awarded ◻ Yes ◻ No ◻ Honours
Major subject_______________________________________________________________________________

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Other courses, workshops, seminars_____________________________________________________________
Licences, Certificates, Degrees_________________________________________________________________

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WORK-RELATED SKILLS
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Describe any of your work-related skills, experience or training that relates to the position being applied for.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

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EMPLOYMENT
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Name of present/last employer_________________________________Job title__________________________
Period of employment (includes time spent away from work due to disability or maternity/parental leave but it is not necessary to refer to this)
From______________________To______________________

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Type of Business____________________________________________________________________________
Reason for leaving (do not refer to issues related to maternity/parental leave, Workers' Compensation claims, handicap/disability, or human rights complaints)____________________________________________________
__________________________________________________________________________________________

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Functions/Responsibilities_____________________________________________________________________
__________________________________________________________________________________________

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Name of previous employer_________________________________Job title_____________________________
Period of employment (includes time spent away from work due to disability or maternity/parental leave but it is not necessary to refer to this)
From______________________To______________________

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Type of Business____________________________________________________________________________
Reason for leaving (do not refer to issues related to maternity/parental leave, Workers' Compensation claims, handicap/disability, or human rights complaints)____________________________________________________
__________________________________________________________________________________________

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Functions/Responsibilities_____________________________________________________________________
__________________________________________________________________________________________

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Name of previous employer_________________________________Job title_____________________________
Period of employment (includes time spent away from work due to disability or maternity/parental leave but it is not necessary to refer to this)
From______________________To______________________

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Type of Business____________________________________________________________________________
Reason for leaving (do not refer to issues related to maternity/parental leave, Workers' Compensation claims, handicap/disability, or human rights complaints)____________________________________________________
__________________________________________________________________________________________

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Functions/Responsibilities_____________________________________________________________________
__________________________________________________________________________________________

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For employment references we may approach:

Your present/last employer? ◻ Yes ◻ No
Your former employer(s)? ◻ Yes ◻ No

List references if different than above on a separate sheet.
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PERSONAL INTERESTS AND ACTIVITIES (civic, athletic etc.)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

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I hereby declare that the foregoing information is true and complete to my knowledge. I understand that a false statement may disqualify me from employment, or cause my dismissal.

Have you attached an additional sheet? ◻ Yes ◻ No

Signature_________________________________________________Date______________________________

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