GENERAL INFORMATION

Driver's License Number:

Physical Limitations/Health Problems:

Have you ever received compensation for any injuries?
Yes No
If so, please specify date and type of injury


Do you have any First Aid training?
Yes No
Specify:

List any other courses, licenses or special qualifications:


Will you work:
Day Shift Afternoon Night Shift Weekends

Are you limited to any specific hours? or days? Specify:

Maximum you can lift:

Do you have safety footwear? Yes No

PAYROLL INFORMATION

Method of payment: Cheque Direct Deposit
(Please provide voided cheque)
Federal tax deducted as single unless otherwise specified.
Pay periods bi-weekly starting

First Day Worked

Last Day Worked

Pay Rate (Includes 4% vacation pвy unless otherwise stated)

The position can be terminated or extended by the Employer at any time.