Employment Application Form

* fields are required

PERSONAL INFORMATION

First Name *

Last Name *

Apartment/Unit #

Street Address *

City *

Province *

Postal Code *

Phone 1 *

Phone 2

E-mail Address *

GENERAL INFORMATION

Position(s) applied for: *

Are you age 18 or older:
—Please choose an option—YesNo

Are you legally entitled to work in Canada?
—Please choose an option—YesNo
Upon employment we will request your Social Insurance Number (“SIN”) and/or any government document that can confirm your SIN or eligibility to work in Canada.

EDUCATION

Highest level of education completed: *

School/Institute: *

Additional License(s) and/or Certificates:

EMPLOYMENT HISTORY

Position 1 *

Company 1 *

Start Date 1 *

End Date 1 *

Position 2

Company 2

Start Date 2

End Date 2

Position 3

Company 3

Start Date 3

End Date 3

Please identify the kind of employment you are interested in:
Full-time onlyPart-time onlyPart-time or full-time

Please identify shifts you are available to work: *
DayAfternoonEve.WeekendsAny shift

What date are you available to start work?

WORK-RELATED REFERENCES

Please provide three employment related references, including your current supervisor (if applicable).

Name and Title 1: *

Employment Relationship 1: *

Company, Phone Number, Email 1: *

Name and Title 2:

Employment Relationship 2:

Company, Phone Number, Email 2:

Name and Title 3:

Employment Relationship 3:

Company, Phone Number, Email 3:

USE OF PERSONAL INFORMATION

All information provided in this form, supporting resume and/or cover letter is considered confidential as defined by the BC Personal Information Protection Act “PIPA”). Haro Park Centre will only use this information to manage the application and selection of candidates for employment. You consent and authorize Haro Park Centre to contact the references provided for the purposes of considering your application for employment. You understand that information obtained from your references is provided to Haro Park Centre in confidence and will not be disclosed to you. Falsification of this information or omission of any pertinent information during the selection process may disqualify your employment. Applicants agree to undergo, as needed: criminal record check, drivers license abstract review, provincial license/credential verification; pre-placement health assessment and TB screening, which are relevant to jobs at Haro Park Centre.

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