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Friday, July 30th, 2010
Application Form
HDC
»
Careers and Job Postings
» Application Form
Personal Information
Application Date: 2010-07-30
Date Available:
Name:
Last
*
First
*
Middle
*
Current Address:
Street
*
City
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario *
Prince Edward Island
Quebec
Saskatchewan
Yukon
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Postal/Zip Code
*
Phone:
Home Phone 555-555-5555
*
Business Phone 555-555-5555
Position Appling For
Production
Office
Truck - What Type of License?
Student Production
Co-op/Office Student
Other: Specify
Working Conditions
Please put a check beside any of the following if you would
NOT
be able to work under these conditions:
Continental Shifts
Day Shifts
Weekends
12 Hour Shifts
Night Shifts
Afternoon Shifts
Rotating Shifts
Work History #1
Company Name:
Company Address:
Type of Business:
Company Telephone:
555-555-5555
May we contact this employer?
Yes
No
From:
Month
Year
To:
Month
Year
Weekly Salary:
Job Duties / Responsibilities:
Reason For Leaving:
Work History #2
Company Name:
Company Address:
Type of Business:
Company Telephone:
555-555-5555
May we contact this employer?
Yes
No
From:
Month
Year
To:
Month
Year
Weekly Salary:
Job Duties / Responsibilities:
Reason For Leaving:
Work History #3
Company Name:
Company Address:
Type of Business:
Company Telephone:
555-555-5555
May we contact this employer?
Yes
No
From:
Month
Year
To:
Month
Year
Weekly Salary:
Job Duties / Responsibilities:
Reason For Leaving:
Education
Institution
Currently Enrolled
Name
No. Mths/Yrs Completed
Program/Degree/Diploma/
Certificate/License
High School
0
1
2
3
4
5
6
7
8
9
10
11
Months
0
1
2
3
4
5
6
Years
College / University
0
1
2
3
4
5
6
7
8
9
10
11
Months
0
1
2
3
4
5
6
Years
Technical Training
0
1
2
3
4
5
6
7
8
9
10
11
Months
0
1
2
3
4
5
6
Years
Trades Training
0
1
2
3
4
5
6
7
8
9
10
11
Months
0
1
2
3
4
5
6
Years
Apprenticeship
0
1
2
3
4
5
6
7
8
9
10
11
Months
0
1
2
3
4
5
6
Years
0
1
2
3
4
5
6
7
8
9
10
11
Months
0
1
2
3
4
5
6
Years
Have you had any training and/or experience with any of the following? Include Jobs, Volunteer Work and School
Forklift
Trucks
Heavy Equipment
Elevator or Processing Equipment
Extra-Curricular Activities
Have you ever volunteered or participated on any committees, teams or special projects? If yes, please explain the role of the team(s), your role and the results.
Performance Recognition
Have you received any special awards, recognition or bonuses for outstanding performance? If yes explain why.
Past Experience
Please read the tasks listed below and indicate with a check in the yes/no box if you have had 6 months or more previous experience doing each task. This includes past jobs, volunteer work, and/or school experience.
Previous Experience
If yes,
list specific examples
Interested
in doing work?
Have you ever operated farm machinery?
Yes
No
Yes
No
Have you operated a fork lift?
Yes
No
Yes
No
Have you had a job that required shift work?
Yes
No
Yes
No
Have previous jobs required learning more than one job or task?
Yes
No
Yes
No
Have you worked with others as a team player?
Yes
No
Yes
No
Past Discipline/Discharge
Have you ever been discharged from employment or been given a disciplinary suspension?
Yes
No
Company Name:
Reason for Discharge or Suspension:
Comments that you have about the action taken against you.
Criminal Record
Have you ever been convicted of a criminal offense (Criminal Code of Canada) for which a pardon has not been granted?
Yes
No
Other Information
