APPLICATION FOR EMPLOYMENT
KILLARNEY CARTWRIGHT CONSUMERS C0-0P
DAVE RUF General Manager PH:(204)523-5052
The information on this application form will be used to evaluate your suitability for employment. If hired, the information will be used to communicate with you on any matters relating to your employment and to determine your suitability for future promotion within the Co-operative or the Co-operative Retailing System. Please carefully read and complete all areas of this application.

Last Name: First Name:   RESUME ATTACHED: YES NO
 
Address: City:
 
Province: Postal Code: Telephone:( )- (day) Telephone:( )- (evening)
 
Have you ever been convicted of an offense(other than a traffic violation)for which a pardon has not been granted? Yes If yes, explain (If additional space required, attach a     separate letter).

Are You presently bondable?
Yes No

Has your bond ever been revoked?
Yes No
No  
Do you have a disability or condition which will affect your ability to perform any of the functions of the job for which you have applied?    

Are you legally entitled to work in Canada?
Yes No

Yes If yes, explain what functions you cannot perform and what accommodations could be made which would allow you to do the work adequately. (If additional space required,attach separate letter).
No  
 

Location Preferred: Reason:

If necessary, would you accept a transfer?

Yes No
 
Type of Work Preferred: 1. 2. 3.
 

Date Available:

 Preference for (If applicable)
Full-Time  Part-Time  Casual 		Availability:
Days Evenings Nights Weekends
 
Salary Required: Who referred you to our organization:
 
         
EDUCATION
DATES ATTENDED
SCHOOL NAME AND ADDRESS
MAJOR FIELD
ATTAINMENT
HIGH SCHOOL FROM :
Month   Year
TO:
Month   Year 		NAME:
Location:
Province:
Academic
Vocational
Other


Highest Grade Completed
Achieved Required Credits
Yes No
         
COLLEGE OR UNIVERSITY FROM :
Month   Year
TO:
Month   Year 		NAME:
Location:
Province: 		   
         
BUSINESS, TRADE OR OTHER SCHOOL FROM :
Month   Year
TO:
Month   Year 		NAME:
Location:
Province: 		   
         
         
EMPLOYMENT HISTORY (BEGIN WITH MOST RECENT) Circle the number of the employer whom you do not wish us to contact at this time. 1 2 3
1. COMPANY NAME:   TELEPHONE: ( )
STREET ADDRESS: CITY: Province: POSTAL CODE:
TYPE OF BUSINESS:
 NATURE OF DUTIES FROM START TO LEAVING:
POSITION:
FULL-TIME PART-TIME TEMP
STARTING SALARY$
CURRENT SALARY $
EMPLOYMENT:
FROM :
Month   Year
TO:
Month   Year
REASON FO LEAVING:
 IMMEDIATE SUPERVISOR:
NAME
TITLE:
     
 
EMPLOYMENT HISTORY (BEGIN WITH MOST RECENT) Circle the number of the employer whom you do not wish us to contact at this time. 1 2 3
2. COMPANY NAME:   TELEPHONE: ( )
STREET ADDRESS: CITY: Province: POSTAL CODE:
TYPE OF BUSINESS:
 NATURE OF DUTIES FROM START TO LEAVING:
POSITION:
FULL-TIME PART-TIME TEMP
STARTING SALARY$
CURRENT SALARY $
EMPLOYMENT:
FROM :
Month   Year
TO:
Month   Year
REASON FO LEAVING:
 IMMEDIATE SUPERVISOR:
NAME
TITLE:
     
 
EMPLOYMENT HISTORY (BEGIN WITH MOST RECENT) Circle the number of the employer whom you do not wish us to contact at this time. 1 2 3
3. COMPANY NAME:   TELEPHONE: ( )
STREET ADDRESS: CITY: Province: POSTAL CODE:
TYPE OF BUSINESS:
 NATURE OF DUTIES FROM START TO LEAVING:
POSITION:
FULL-TIME PART-TIME TEMP
STARTING SALARY$
CURRENT SALARY $
EMPLOYMENT:
FROM :
Month   Year
TO:
Month   Year
REASON FO LEAVING:
 IMMEDIATE SUPERVISOR:
NAME
TITLE:
     
 
OTHER TIME
Account for your time during any interval of unemployment other than when you were attending school.(You may decline to list ministers of religion)
DATE (MONTH AND YEAR):

FROM :
Month   Year
TO:
Month   Year 		EXPLAIN:
REFERENCES
Give three references who have known you well during the last five or more years excluding relatives & former employers. (You may decline to list ministers of religion)
   
NAME INCLUDE FIRST NAME OR INITIALS
ADDRESS NO. AND STREET CITY OF TOWN PROVINCE
TELEPHONE
YEARS KNOWN
PRESENT OR MOST RECENT OCCUPATION

( )

( )

( )
         
ADDITIONAL INFORMATION
Co-op background, Interests, extracurricular activities, special skills such as equipment operator, language spoken/written, computer skills, academic honors, scholarships, etc. (You may decline to list organizations that would depict your race, religion or disabilities).
Please give a short description of the information you would like us to know.
         

I HEREBY CONSENT TO THE COLLECTION OF THE INFORMATION IN THIS APPLICATION AND TO ITS USE FOR THE STATED PURPOSE UPON CONFORMATION BY PHONE THAT I DID IN FACT SUBMIT THIS APPLICATION.

I ALSO CONSENT TO HAVE AN INVESTIGATION OF WORK AND PERSONAL REFERENCES, CRIMINAL RECORD AND CREDIT. UPON CONFORMATION BY PHONE THAT I DID IN FACT SUBMIT THIS APPLICATION, I UNDERSTAND THAT ANY MISREPRESENTATION OR OMISSION OF FACTS IS CAUSE FOR CANCELLATION OF THIS APPLICATION OR TERMINATION OF EMPLOYMENT.

NAME OF APPLICANT: DATE:

RESUME: