Untitled Document

CANADIAN TEAM MEMBER APPLICATION

Date:
Position Applying For:

Personal Information
Last Name:
First Name:
Middle Name:
Home Phone Number:
Mobile Phone Number:
Address (current):
City:
State:
Zip:
Email Address:

Education/Skills
Junior/High School
College/University
Business/Trade
Other
Are you at least 18 years of age?	Yes No
Are you legally able to work in Canada?	Yes No
Do you have a valid Driver's License?	Yes No
Do you have a Social Insurance Number?	Yes No
Have you ever been convicted of an offence other than a traffic violation, for which you have not been granted a pardon?	Yes No
If yes, please explain:
Have you ever worked for us before?	Yes No
If yes, when?
Do you have relatives employed by this company?	Yes No
Employee name and department:
Do you have any limitations that would preclude you from performing any functions of the position you are applying for?	Yes No
If yes, explain & advise of any accommodations which may be required:

Hours Available
Number of hours available to work per week:
Times not available:
Earliest Time Available:	Sunday
	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday
Latest Time Available:	Sunday
	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday

Employment History	List your last three positions, starting with present or most recent employer. It is understood that :10 Minute Manicure reserves the privilege of contacting past employers regarding references.
If you are currently employed, may we contact your employer at this time?	Yes No
1. Name of Company:
Phone Number:
Position Held:
Employment Dates:	From: To:
How Long (years/months):
Name of Supervisor:
Rate of Pay:	Start: $ Final: $
Brief Description of Duties Performed:
Reason for leaving:
2. Name of Company:
Phone Number:
Position Held:
Employment Dates:	From: To:
How Long (years/months):
Name of Supervisor:
Rate of Pay:	Start: $ Final: $
Brief Description of Duties Performed:
Reason for leaving:
3. Name of Company:
Phone Number:
Position Held:
Employment Dates:	From: To:
How Long (years/months):
Name of Supervisor:
Rate of Pay:	Start: $ Final: $
Brief Description of Duties Performed:
Reason for leaving:

References	Please list three references we may contact:
Name:
Phone (work):
Phone (home):
Name:
Phone (work):
Phone (home):
Name:
Phone (work):
Phone (home):

Tell us why you are a great candidate for this position:

	I certify that my answers to these questions are complete, true and correct to the best of my knowledge. I understand that if employed, falsified statements, misrepresentation, or omission of facts may be cause for termination. I hereby consent to the release of all relevant information obtained from any agency including references, security checks and credit investigations.


Date:
Signature: