Y
..
Sunset Residential & Rehabilitation
P. O . BOX 130
PUGWASH, N.S.
Services Incorporated
B0K 1L0
PHONE:
243-2571; 243-2572
FAX: 243-3222
APPLICATION FOR EMPLOYMENT
(Effective for a period of six months only)
SURNAME
GIVEN NAMES
PREFERRED NAMES
RESIDENCE ADDRESSES
DATE OF RESIDENCE
PRESENT ADDRESS
TELEPHONE NUMBER
FROM:
TO:
PREVIOUS ADDRESS
PRESENT
FROM:
TO:
NEXT TO PREVIOUS ADDRESS
FROM:
TO:
HEALTH
APPROXIMATE DATE OF LAST PHYSICAL EXAMINATION
DO YOU HAVE ANY DISABILITIES WHICH MIGHT IMPAIR YOUR PERFORMANCE ON THE POSITION APPLIED FOR?
IF YES, PLEASE EXPLAIN:
POSITION
TYPE OF EMPLOYMENT
FULL-TIME
CASUAL
SUMMER
❏
❏
❏
TYPE OF WORK PREFERRED
FIRST CHOICE
SECOND CHOICE
Are you over 16 and
IF NO PLEASE
Under 65 years of Age: YES .....................................................NO .................................................................state age: ..............................................
DO YOU HAVE A: VALID DRIVER’S LICENSE: YES .................................................................................. NO............................................................
CLASS 4 LICENSE:
YES .................................................................................. NO............................................................
PREVIOUSLY EMPLOYED BY SUNSET SERVICES: YES ......................................................................... NO............................................................
IF YES - DEPARTMENT ..............................................................FROM ...............................................................TO ....................................................
IF APPOINTED, WHEN COULD YOU REPORT FOR WORK ..........................................................................................................................................
EDUCATION
TYPE
ELEMENTARY
SECONDARY
MAJOUR SUBJECT(S)
YEAR
COMPLETED
AWARDS/
SCHOLARSHIPS
FINAL
YEAR
AVERAGE
DIPLOMA/
DEGREE
❏
VOCATIONAL ❏
COMMERCIAL
ACADEMIC
❏
COMMUNITY COLLEGE
BUSINESS SCHOOL
UNIVERSITY
OTHER FORMAL EDUCATION
PLEASE DESCRIBE ANY SPECIAL SKILLS YOU HAVE ACQUIRED THROUGH EXPERIENCE OR TRAINING (Such as the use of office machines, shorthand, carpentry,
nursing, etc.)
DO YOU HAVE MEMBERSHIPS IN BUSINESS OR PROFESSIONAL ORGANIZATIONS? (Do not refer by name to organizations of Religious, Ethnic or National Nature.)
VOLUNTARY WORK EXPERIENCE: Sunset Services recognizes the value of practical, voluntary, community and homemaking experience. Describe such experience in detail, if you consider it relevant to the position or type of work for which you are applying. Include dates of involvement and approximate hours per week
devoted to such activity.
...........................................................................................................................................................................................................................................................................
...........................................................................................................................................................................................................................................................................
BUSINESS HISTORY
NAME OF EMPLOYER
EMPLOYEER’S ADDRES
(Please complete for your three most recent jobs).
SALARY
DATES OF EMPLOYMENT
FROM:
START:
TO:
FINAL:
NATURE OF BUSINESS
REASON FOR LEAVING
JOB TITLE
NAME OF EMPLOYER
EMPLOYEER’S ADDRES
DESCRIPTION OF YOU DUTIES AND RESPONSIBILITIES
SALARY
DATES OF EMPLOYMENT
FROM:
START:
TO:
FINAL:
NATURE OF BUSINESS
REASON FOR LEAVING
JOB TITLE
NAME OF EMPLOYER
EMPLOYEER’S ADDRES
DESCRIPTION OF YOU DUTIES AND RESPONSIBILITIES
FROM:
START:
TO:
FINAL:
NATURE OF BUSINESS
REASON FOR LEAVING
JOB TITLE
SALARY
DATES OF EMPLOYMENT
DESCRIPTION OF YOU DUTIES AND RESPONSIBILITIES
HAVE YOU EVER BEEN DISCHARGED OR REQUESTED TO RESIGN FROM A POSITION? (If so, please explain).
HAVE YOU EVER HAD A BOND DENIED OR REVOKED? (If so, why?)
SU
HAVE YOU BEEN CONVICTED OF A CRIMINAL OFFENCE FOR WHICH YOU HAVE NOT RECEIVED A FULL PARDON? (If so, please explain).
R
P
DO YOU HAVE A CURRENT CRIMINAL RECORDS/VULNERALBE PERSONS RECORDS CHECK?
P
LIST REFERENCES, PREFERABLY FORMER EMPLOYERS AND OTHER BUSINESS OR PROFESSIONAL PERSONS, WHOM WE MAY CONTACT
POSTION
NAME
MAILING ADDRESS
YEARS
KNOWN
TELEPHONE NUMBER
N
H
A
D
IF
IS THER ANY OTHER INFORMATION WHICH YOU CONSIDER PERTINENT TO YOUR APPLICATION?
P
F
C
S
PRE-EMPLOYMENT STATEMENT
I CERTIFY THAT THE FOREGOING STATEMENTS ARE COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, I
AUTHORIZE SUNSET SERVICES TO OBTAIN SUCH FURTHER INFORMATION FROM OTHER AS IT MAY REASONABLY REQUIRE. IO
ACKNOWLEDGE AND AGREE THAT THE FALSIFICATION OF ANY INFORMATION ON THIS APPLICATION FOR EMPLOYMENT FORM MAY
RESULT IN MY IMMEDIATE DISCHARGE FROM EMPLOYMENT WITHOUT FURTHER NOTICE.
DATE: ............................................................................................................SIGNATURE ...............................................................................................
(Effective for a period of 6 months from date of filing.)
YOUR INTEREST IN EMPLOYMENT WITH SUNSET SERVICES IS APPRECIATED.
To assist in the proper assessment of your qualifications, you are requested to complete this form carefully and in detail.
A resume may be included as a separate attachement. Submit copies only of personal documents.