CN 98331

Metro Ontario Inc.

Employment Application Please print clearly in ink – Answer all questions completely
Position Applied for:

Type of Employment: Full Time Part Time Location: Store Distribution Centre Pharmacy

Personal Data
Last Name First Name Middle Name

Address Apt/Unit # City

Province Postal Code Home Telephone # Alternate Telephone #

Have you ever worked for our company? Yes No

Position: From: To: Location:
Do you have a spouse, child, or parent employed by our organization? Yes No
If yes please indicate relationship? and work location:

Are you under the age of 18? : Yes No If lifting is a bona fide occupational requirement are you
capable of heavy repetitive lifting? Yes No
If yes, please state your age

Are you currently enrolled in school? Yes No Are you legally entitled to work in Canada: Yes No

Educational Background
Secondary School Business, Trade or Technical School

Highest Grade or Level Completed Name of Course

Diploma Received? Yes No Length of Course

License, Certificate or Diploma Received? Yes No

Specify
Specify

Community College University

Name of Course Name of Course

Length of Course Length of Course

Diploma Received? Yes No Degree Received? Yes No

Specify Specify

Other courses, workshops, seminars or work related skills:

 Revised October 2008
Employment History
Name & Address of Present /Previous Employer
Type of Business: Telephone Number:
Period of Employment: From: To:
Job Title: Supervisor’s Name:
Duties / Responsibilities:
Reason for Leaving:

Name & Address of Present /Previous Employer

Type of Business: Telephone Number:
Period of Employment: From: To:
Job Title: Supervisor’s Name:
Duties / Responsibilities:
Reason for Leaving:

Other
For employment references may we approach your present employer? Yes No Your previous employer? Yes No
List references if different than above on a separate sheet. Have you attached an additional sheet? Yes No
Have you ever been convicted of a criminal offence, other than one for which a pardon has been granted under the
Criminal Records Act (Canada)? Yes No If yes, please provide particulars:
I understand my employment may be contingent upon completion of a Criminal Record Check and its review. Yes No

Availability
If the location you are applying to is open seven days per week, Sunday through Saturday please indicate your preferred hours specifying
a.m. or p.m. We encourage you to be as flexible as possible as availability will be considered in any hiring decision. It is understood that you
may be required to work during different days or hours than you have specified below.
Preferred
Hours Sunday Monday Tuesday Wednesday Thursday Friday Saturday

From
To

Please confirm that you are willing and available to work Sunday Yes No Saturday Yes No
I hereby authorize investigation of all statements obtained in this application including the obtaining of a Criminal Record Check to Metro
Ontario Inc. I affirm said information is true and complete to my knowledge and I understandthat any misrepresentation, falsification or
willful omission herein shall be sufficient reason for dismissal from, or refusal of employment.

Applicant Signature Date: / /

THIS SECTION TO BE COMPLETED BY INTERVIEWER – AFTER HIRING * PLEASE PRINT CLEARLY *

HIRED AS: FT PT DEPARTMENT: LOCATION:

RATE OF PAY: $ START DATE:

INTERVIEWED BY: TITLE:

/ /
Print Name Signature Date

Visit us at: www.metro.ca