APPLICATION
FOR
EMPLOYMENT
We at Plato’s Closet St. James are committed to a policy of equal treatment and opportunity in every
aspect of our employment relations without regard to race, ancestry, place of origin, ethnic origin, colour,
citizenship, creed, sex, sexual orientation, age, marital status, family status, disability, or any other legally
protected class status. This includes, but is not limited to, recruiting, hiring selection for training, transfers,
promotion, compensation, and any company sponsored social and recreational programs.
PLEASE EMAIL
Name _______________________________________________________________________ Date ________________________________________
Present Address ___________________________________________________________________________________________________________
Address City Province Postal Code
Email Address SIN # (optional) ______________________ Telephone (___) ___________________
Referred by ___ Advertisement ___ Agency ___ Person ___ Other _________________________________________________
Are you legally entitled to employment in Canada? ___ Yes ___ No Are you between 18 and 65? ___________________________________
If under 18, please state your age: ________________________________
Position applying for _______________________________________________________________ Salary expected __________________________
Are you available to work ___ Full-time ___ Part-Time Specify schedule limitations ____________________________________________
Date available for work _______________________________ List friends or relatives in our employ _______________________________________
Were you previously employed by us? ___ Yes __ No If yes, when _______________________________________________________
Other name(s) used while attending schools or places of employment indicated on this form _______________________________________________
Can you perform the primary functions of this job with or without reasonable accommodation? __ Yes __ No
Have you ever been convicted of a criminal offence for which a pardon has not been granted? __ Yes __ No If yes, please explain: (Note - a
conviction alone will not automatically bar you from employment.)
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Military Service? __ Yes __ No Branch of Service and Rank _______________________Dates of Service______________________________
Special Training ___________________________________________________________________________________________________________
EDUCATION
Course Scholastic Dates of Graduated
of Study Average Attendance
Name and Location
Yes/No Degree
High School/GED
N/A N/A N/A
College/University
Vocational
Other
Additional comments regarding education _____________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
SKILLS
List Computer Software Packages in which you are proficient _____________ What languages do you:
_______________________________________________________________ speak fluently ______________________________
Point of Sale System (cash register)___________________________________ write fluently _______________________________
Other Skills _____________________________________________________ read fluently _______________________________
EMPLOYMENT HISTORY
(List present or most recent employer first)
Name of Company __________________________________ Address ________________________________________________________________
Supervisor _________________________________________ Salary _______________ Phone ____________________________________________
Job Title ________________________________________________________ Date Started __________________ Date Left ___________________
Job Description ___________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Reason for Leaving:
Name of Company __________________________________ Address ________________________________________________________________
Supervisor _________________________________________ Salary _______________ Phone ____________________________________________
Job Title _________________________________________________________Date Started __________________ Date Left ___________________
Job Description ____________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Reason for Leaving:
Name of Company __________________________________ Address ________________________________________________________________
Supervisor _________________________________________ Salary _______________ Phone ____________________________________________
Job Title _________________________________________________________Date Started __________________ Date Left ___________________
Job Description ____________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Reason for Leaving:
Name of Company __________________________________ Address ________________________________________________________________
Supervisor _________________________________________ Salary _______________ Phone ____________________________________________
Job Title _________________________________________________________Date Started __________________ Date Left ___________________
Job Description ____________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Reason for Leaving:
AUTHORIZATION FOR BACKGROUND CHECK: I Plato’s Closet Winnipeg St. James to verify employment,
except as noted below, as well as conduct criminal and vehicular record check.
Indicate those you do not wish contacted:________________________________________________________________________________________
Signed: ______________________________________________________________________________Date: _______________________________
REFERENCES
Please list three persons other than relatives or personal friends, who can judge your work ability.
1) Name _________________________________________________________ Occupation ______________________________________________
Address ______________________________________________________________________ Phone ____________________________________
2) Name _________________________________________________________ Occupation ______________________________________________
Address ______________________________________________________________________ Phone ____________________________________
3) Name _________________________________________________________ Occupation ______________________________________________
Address ______________________________________________________________________ Phone ____________________________________
Please use the space provided below to summarize any additional information necessary to fully describe your qualifications.
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
*** PLEASE READ ***
All information written on this application is complete and accurate to the best of my knowledge. I understand that any misrepresentation of facts in this
application disqualifies me from further consideration - or if employed - is grounds for dismissal. I understand that any employment offer is contingent
upon satisfactory references and I authorize Plato’s Closet Winnipeg St. James to investigate past employment and education history, as well as
references.
I fully understand and agree to all statements above.
_______________________________________________________ _________________________________________________
Signature Date
OFFICE USE ONLY
Interviewed by _____________________________________________________________________ Date __________________________________
Referral Source _______________________________________________________________ Hired _________________ Not Hired _____________
Starting Date ___________________________ Position ________________________________________________ Salary _____________________
Location ______________________________________ Reporting To ___________________________
