Application for Employment
PERSONAL AND CONFIDENTIAL
By completing and submitting this application for employment form, you hereby consent to Co-op’s use of the information provided by
you on this form to determine your qualification and suitability for employment. The information will also be used to communicate with
you on any matters relating to your application for employment. Please carefully read and complete all areas of this form.
Name: Last First Second Resume Attached:
Yes No
Address: No. And Street City or Town Province Postal Code Telephone:
Email:
Are you legally entitled to work in Canada? Yes No
Have you ever been convicted of a criminal offence for which a pardon has not been granted? Yes No
Have you ever been employed by Co-op? Yes No
Preferred Work Location: If necessary, would you accept a transfer? Yes No
Position you are applying for:
Salary Expectations: How did you find out about the position?
Website Referral Online Other
Availability: Preference for (if applicable):
Days Evenings Nights Weekends Full-Time Part-time Casual
ONLY COMPLETE EDUCATION AND EMPLOYMENT HISTORY IF YOU ARE NOT ATTACHING A RESUME AND COVER LETTER
Education Year Completed School Name And Major Field Attainment
Address
College or University Specify Degree Or
Diploma Obtained:
Business, Trade Specify Certification
or Other School Obtained:
High School Highest Grade Achieved Required
Completed: Credits?
Yes No
EMPLOYMENT HISTORY (begin with most recent)
Company Name:
Type Of Business:
Position Title: Key Responsibilities
Full-Time Part-Time Temporary
Employed: Reason For Leaving
From: , To: ,
Month, Year Month, Year
Application for Employment
EMPLOYMENT HISTORY continued
Company Name:
Type Of Business:
Position Title: Key Responsibilities
Full-Time Part-Time Temporary
Employed: Reason For Leaving
From: , To: ,
Month, Year Month, Year
Company Name:
Type Of Business:
Position Title: Key Responsibilities
Full-Time Part-Time Temporary
Employed: Reason For Leaving
From: , To: ,
Month, Year Month, Year
REFERENCES – PLEASE PROVIDE 2-3 REFERENCES (preferably from people you have reported to)
Name Title Telephone Email Relationship
(Include First and Last Name)
Co-op is collecting your personal information provided by way of this application form, and will use and disclose your personal information, only for reasonable purposes
related to potentially establishing, and if hired, managing and terminating your employment relationship with Co-op. Without limiting the foregoing, Co-op may disclose
the personal information that you provide to it by way of this application form to third party service providers (such as payroll and benefits companies under contract with
the Co-op, background check service providers). Positions that are safety sensitive may require as a pre-condition to employment a drug and alcohol test and a fitness to
work medical examination. Co-op has implemented reasonable measures to ensure that the personal information which you provide to it is maintained accurately, kept
current and only for a reasonable amount of time, is secure and confidential. For further information regarding Co-op’s privacy policies, please contact the privacy officer at
your local Co-op. By completing and submitting this application form you consent to the collection, use and disclosure of your personal information for these purposes.
• Your submissions of this application for employment certifies that:
• You authorize Co-op to contact any of the references provided by you for the purpose of reference check;
• You authorize the verification of the above information by Co-op and consent to any other necessary and reasonable inquires that may be required as it relates to the
position that you are being considered for, such as a criminal record check;
• You understand that this application for employment does not constitute an employment offer;
• All information in this application is correct and complete to the best of your knowledge and belief; and
• You understand that any false or misleading information provided in this application form could result in a refusal of employment, withdrawal of offer or termination
of employment.
SIGNATURE OF APPLICANT: DATE:
