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			Scotia Glass Employee Application Form Please fill out all fields in the form below. Thank you! Email or print/fax to 902-866-1421   PERSONAL Name ____________________________________________________________________ Present Address ____________________________________________________________ Telephone No. Business __________________ Residence_________________________ May we contact you at your business number? Yes ( ) No ( ) Position(s) applied for  _______________________ Rate of pay expected $ ________ per How did you learn of this opening? ________________________________________________________   Desired Work: Part Time? ( ) Temporary? ( ) Full Time? ( ) Are you legally entitled to work in Canada? Yes ( ) No ( ) Have you worked with us before? _____ If Yes, when? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________   Preferred Location to work at: (see locations section of web site) _______________________________   Knowledge of: Driver/Warehouse ( ) Office Work ( ) Glasswork ( ) Supervisory ( ) Sales ( ) Are there any experiences, skills or qualifications which you feel would especially fit you for work with us? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________   If hired, do you have a reliable means of transportation to get to work? ____________________ Bondable? ( )   EDUCATIONAL BACKGROUND Type of School Name and Address From (year) To (year) Graduated Course/Major High School       Yes ( ) No ( )   Secondary School       Yes ( ) No ( )     College       Yes ( ) No ( )   Post Graduate       Yes ( ) No ( )   Business or Trade       Yes ( ) No ( )   Other - Courses, seminars or workshops       Yes ( ) No ( )    PRIOR WORK HISTORY (List in order, last or present employer first) DATES Name and Address of Employer RATE OF PAY Supervisor’s Name and Phone Number Reason for Leaving From To             Start Finish                 May we contact the employers listed above? _____ If not, indicate below which one(s) you do not wish us to contact. _____________________________________________________________________________ _____________________________________________________________________________   ADDITIONAL INFORMATION Describe the kind of work desired and your career ambitions in relation to your training and your experience ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________   Would you consider a different type of work from the above? Yes ( ) No ( ) Available to start work on or around what date? ___________________________________________________________   Do you require notice before you would be able to start work? _______________________________________________   Have you ever been convicted of a criminal violation? Yes ( ) No ( ) If yes, please give the date and nature of the offence. ______________________________________________________   Please list any leisure activities, social interests, memberships of clubs or volunteer work you might be associated with in which you feel may be of interest to us. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________   PLEASE READ CAREFULLY APPLICANT’S CERTIFICATE I hereby certify that to the best of my knowledge and belief the information in this application is compete and true. SIGNATURE OF APPLICANT ___________________________________ DATE _____________________________