POSITION APPLIED FOR: FULL LEGAL NAME: SOCIAL INSURANCE NUMBER: PHONE NUMBER: PLEASE LIST ADDRESSES FOR PAST 3 YEARS. CURRENT ADDRESS: HOW LONG? PREVIOUS ADDRESS: HOW LONG? PREVIOUS ADDRESS: HOW LONG? DATE OF BIRTH: Can you provide proof of age? HAVE YOU WORKED FOR THIS COMPANY BEFORE?  No Yes WHEN? From To   Position: Reason for Leaving: ARE YOU NOW EMPLOYED? No Yes IF NOT, HOW LONG SINCE LEAVING LAST EMPLOYMENT? REASON FOR LEAVING LAST EMPLOYER: WHO REFERRED YOU? EXPECTED RATE OF PAY: Is there any reason why you may be unable to perform the functions of the job for which you have applied? PLEASE PROVIDE THE FOLLOWING INFORMATION ON ALL EMPLOYERS DURING THE PRECEDING 7 YEARS. LIST COMPLETE MAILING ADDRESSES, STREET NUMBERS, CITIES, PROVINCES AND POSTAL CODES. EMPLOYER: DATES: From To Address: Position: Wage: Phone Number: Contact Name: Reason for Leaving: EMPLOYER: DATES: From To Address: Position: Wage: Phone Number: Contact Name: Reason for Leaving: EMPLOYER: DATES: From To Address: Position: Wage: Phone Number: Contact Name: Reason for Leaving: EDUCATION: College High School
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