Address
City
Date of Birth
Telephone
Province & Postal Code
Your Email
Highest Education:
Have you ever worked for a Temporary Agency Before? YesNo
If yes, which Temporary Agency?
What kind of work did you do for this Temporary Agency?
Work Experience List Years, Type of Work, and Specialty Skills:
List any other Education, Training, Special Skills or Certificates that you possess: (check all that apply) WHMISFOODSAFEFORKLIFTFIRST AID
Other, including first aid level if applicable:
Availability Are you generally available to work at any time? YesNo
If you answered "no", please let us know each day/time that you are available. Morning: SundayMondayTuesdayWednesdayThursdayFridaySaturday Afternoon: SundayMondayTuesdayWednesdayThursdayFridaySaturday Evening: SundayMondayTuesdayWednesdayThursdayFridaySaturday
General comments on availability:
Emergency Contact Info Name
E-Mail
Other Information
Do you hold a current driver's license? YesNo
If you answered Yes, please indicate class:
Do you own a car? YesNo
Do you have steel toe work boots? YesNo
Have you had a worker's compensation claim in the past 2 years? YesNo
If you answered Yes, please describe: