Les Entreprises R. Preston: Job

First name*

Last name*

Social Insurance Number (SIN)*

Birthdate (day/month/year)*

Current address*

Appartment

City*

Postal code*

Home phone*

Cell phone

Other

E-mail

If your application is accepted, when you can start working?*

- QUALIFICATIONS -

For what competence level are you making this application?*

Do you have a worker permit or any kind of licenses?* (Please specify in the fields below)

Permit/License (include expiry date)

Education level

Do you have a driver's license?*

If so please specify which class, restriction and expiry date

Have you ever been setenced for a criminal infraction for which you have not obtained any rehabilitation?*

- EXPERIENCE -

1) Last employer (the most recent)

Employer*

Contact person*

Phone number*

Job title*

From (month/year)*

To (month/year)*

Reason for leaving*

2) Second last employer (second most recent)

Employer*

Contact person*

Phone number*

Job title*

From (month/year)*

To (month/year)*

Reason for leaving*

- HEALTH STATUS -

Have you ever had an illness or injury that could be a risk factor in the working environment?*

Do you have a physical handicap that could affect your working capacity?*

Have you ever made any claims to the CSST?*

I hereby claim that all of the information submitted in this form are true and complete. I also hereby agree that any false information provided may nullify my application or can be constituted as a reason for being fired.