The Russell Inn
PRINT & FAX APPLICATION FOR EMPLOYMENT
Please Fax to 204-773-2175
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The Human Rights Codes prohibit discrimination in employment because of race, ancestry, place of origin, colour, national or ethnic origin, citizenship, religion, creed, sex or sexual orientation, age, marital or family status, record of offenses (including an offense in respect of any provincial stature), handicap, disability, language (Province of Quebec). |
Date: __________________
PERSONAL
Name: _____________________________________________________________________
Last
First
Middle Initial
Present Address:
_____________________________________________________________
No.
Street
City
Province
Postal Code
Telephone Number ( ) ___________________________
Job(s) applied for 1. ________________ Rate
of pay expected $ ________ per ________
2. ________________ Rate of pay expected $ ________ per
________
Are there any experiences, skills or qualifications which you feel would especially fit you for work with us?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
PRIOR WORK HISTORY (List in order, last or present employer first)
| DATES | NAME & ADDRESS OF EMPLOYER | RATE OF PAY | SUPERVISOR'S NAME AND TITLE | REASON FOR LEAVING | ||
| FROM | TO | START | FINISH | |||
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| Describe in detail the work you did.
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| DATES | NAME & ADDRESS OF EMPLOYER | RATE OF PAY | SUPERVISOR'S NAME AND TITLE | REASON FOR LEAVING | ||
| FROM | TO | START | FINISH | |||
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| Describe in detail the work you did.
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WORK HISTORY Continued....
| DATES | NAME & ADDRESS OF EMPLOYER | RATE OF PAY | SUPERVISOR'S NAME AND TITLE | REASON FOR LEAVING | ||
| FROM | TO | START | FINISH | |||
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| Describe in detail the work you did.
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May we contact the employers above? _____________________ If not, indicate below which one(s) you do not wish us to contact. __________________________________________________________
PERSONAL REFERENCES
Give the names of at least 3 persons who can supply information pertinent to your job performance (excluding former employers or relatives).
| NAME AND OCCUPATION | ADDRESS | PHONE NUMBER |
| 1. ______________________________ |
_______________________ |
_________________ |
| 2. ______________________________ |
_______________________ |
_________________ |
| 3. ______________________________ |
_______________________ |
_________________ |
Occasionally the form of an application blank makes it difficult for an individual to adequately summarize their complete background. To assist us in finding the proper position for you in our company, use the space below to summarize any additional information necessary to describe your full qualifications.
Thank you for completing this application form and for your interest in employment with us. We would like to assure you that your opportunity for employment with the Russell Inn will be based only on your merit and on no other consideration.
PLEASE READ CAREFULLY APPLICANT'S CERTIFICATION AND AGREEMENT
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal.
Signature of Applicant _________________________________________________________