Application for Employment

Position Applied for: (*)
Preferred Location: (*)
Personal Data
Surname: (*)
First Name: (*)
Middle Name: (*)
Street Address: (*)
City: (*)
Province: (*)
Postal Code: (*)
Home Phone: (*)
Cell Phone:
Work Phone:
Email: (*)

Education and Training
High School/GED
Name of Institute:
Location of Institute:
Grade/Diploma/Degree Completed:
Year Completed:
Commercial, Trade, or Technical Training
Name of Institute:
Location of Institute:
Grade/Diploma/Degree Completed:
Year Completed:
College/University
Name of Institute:
Location of Institute:
Grade/Diploma/Degree Completed:
Year Completed:
Other Continuing Education
Name of Institute:
Location of Institute:
Grade/Diploma/Degree Completed:
Year Completed:
Professional Qualifications/ Memberships/ Licenses if applicable:
*Copies of most relevant education certificates are required
If applying for a position requiring a driver's license, please complete the following:
Do you have a valid driver's license?
Class:
Province: (*)

Employment History(begin with most recent)
Company Name:
Company Address:
Company Phone:
Immediate Supervisor:
Position:
Job Duties:
Worked From:
To:
Reason for Leaving:

Company Name:
Company Address:
Company Phone:
Immediate Supervisor:
Position:
Job Duties:
Worked From:
To:
Reason for Leaving:

Company Name:
Company Address:
Company Phone:
Immediate Supervisor:
Position:
Job Duties:
Worked From:
To:
Reason for Leaving:

Employment References (three)
Name:
Address:
Telephone:
Years Known:
Position or Occupation:

Name:
Address:
Telephone:
Years Known:
Position or Occupation:

Name:
Address:
Telephone:
Years Known:
Position or Occupation:
May we contact your present employer? (*)
May we contact your past employers? (*)
If no, please state reason:

Criminal Records Search Have you ever been convicted of an offense or do you currently have any charges pending under The Criminal Code of Canada, The Narcotics Control Act, or The Food and Drugs Act?
Select an Option (*):
If Yes, please indicate the nature of the offence(s), the date(s) and place(s), and the sentences imposed (if applicable).
If offered a position, I will at my own expense provide the results of a criminal records search by the RCMP or City Police. Employment shall be contingent upon receipt of the criminal record check that is satisfactory to the SCSA.

Declaration
It is understood and agreed that the SCSA may at any time seek verification of the above and further information in considering my suitability for a position at the SCSA. I hereby request and authorize anyone approached by the SCSA, its employees and agents, and anyone providing information pursuant to a request from the SCSA to provide information about me, from any and all claims whatsoever which may arise as a result of the release of such information. I understand and agree that any omission, false or misleading statement may disqualify me from employment or a dismissal. A photographic copy of this authorization shall be valid as the original.
I agree/disagree: (*)
Upload Resume/Cover Letter (*)
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