1. First Name*
2. Last Name*
3. House Number & Street*
4. District
5. Town/City*
6. Country*
7. Postal Code*
8. Phone Number
9. Social Insurance*
10. Date of Birth MM/DD/YY*
11. Email Address*
12. Position Applied For* Labourer Equipment Operator Administration
13. Level of Education* High School College University
14. Drivers Licence Class * Class 1 Class 2 Class 3 Class 4 Class 5
15. Have you ever been bonded* Yes No
16. Will you take a physical exam* Yes No
17. Do you have any experience * Yes No

1. Name*
2. Phone Number
3. Name*
4. Phone Number*

1. Name of Employer*
2. Phone Number*
3. Name of Manager*
4. Dates Employed mm/dd/yy to mm/dd/yy*
5. Reason for Leaving*
6. May We Contact this Employer * Yes No

1. Name of Employer*
2. Phone Number*
3. Name of Manager*
4. Dates Employed mm/dd/yy to mm/dd/yy*
5. Reason for Leaving*
6. May We Contact this Employer * Yes No

The position I am applying for requires me to do various tasks, such as lifting that can weigh anywhere from 35 to 60 pounds, digging with a shovel, raking, lifting bags of seed and fertilizer, sweeping, and operating hand held equipment for periods of time in excess of an 8 hour day. Also sitting for periods of time to operate a tractor when required

If you feel you will be able to fulfill the position, please answer yes below.

1. Will you be able to fufill this position * Yes No

I certify that the information given on this application form is correct

1. Is the information above correct * Yes No