THE CORPORATION OF THE MUNICIPALITY OF ARRAN-ELDERSLIE

1925 Bruce Road 10, Box 70, Chesley, ON  N0G 1L0

519-363-3039   Fax: 519-363-2203   areld@bmts.com ____________________________________________________________________________________________________

 

APPLICATION FORM

 

SECTION 1 (Completed by the applicant)

DATE OF APPLICATION:

DATE AVAILABLE TO START:

ARE YOU CURRENTLY EMPLOYED?

[   ] YES    [   ] NO

POSITION APPLIED FOR:

 

 

SECTION 2 (Completed by the applicant)

FIRST NAME:

 

 

MIDDLE INITIAL:

LAST NAME:

CURRENT ADDRESS:

 

 

APARTMENT NUMBER:

CITY:

PROVINCE:

POSTAL CODE:

 

 

HOME TELEPHONE NO:                                                             ALTERNATE TELEPHONE NO:

 

ARE YOU LEGALLY ELIGIBLE TO WORK IN CANADA?                  [   ] YES    [   ] NO

ARE YOU OVER THE AGE OF 16?                                                               [   ] YES    [   ] NO

DO YOU HAVE A VALID ONTARIO DRIVER'S LICENCE IN GOOD STANDING ? [   ] YES   [   ] NO     CLASS_________

HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE FOR WHICH YOU HAVE NOT RECEIVED A PARDON?     [   ] YES    [   ] NO

DO YOU HAVE ANY RELATIVES WHO WORK FOR THE MUNICIPALITY OF ARRAN-ELDERSLIE?                                      [   ] YES    [   ] NO

IF YES, PLEASE STATE THE NAME OF THE PERSON:

 

SECTION 3 (Completed by the applicant)

EDUCATION:             [  ] Completed Elementary            [  ] Completed High School           [  ] Completed College

                                [  ] Obtained University Degree     [  ] Other (please specify)

PLEASE INDICATE HIGHEST GRADE LEVEL COMPLETED OR DIPLOMA AND/OR DEGREES OBTAINED:

 

 

 

 

SECTION 4 (Completed by the applicant)

ADDITIONAL EDUCATION, LICENCES OR TRAINING:

 

 

 

 

 

 

 

Personal information on this form is collected pursuant to the Municipal Act, 2001, S.O. 2001, C.25, as amended.  This information will be used for the purpose of determining eligibility for employment.


Application Form – Page 2

 

 

SECTION 5 – BEGIN WITH MOST RECENT JOB (Completed by the applicant)

NAME OF EMPLOYER:

TYPE OF BUSINESS:

 

ADDRESS:

PHONE NUMBER:

 

MUNICIPALITY:

PROVINCE

POSTAL CODE:

 

NAME OF SUPERVISOR:

FOR PURPOSES OF OBTAINING EMPLOYMENT INFORMATION MAY WE CONTACT THIS EMPLOYER?             [   ] YES    [   ] NO

DUTIES/RESPONSIBILITIES:

 

 

 

REASON FOR LEAVING (IF APPLICABLE):

 

 

 

NAME OF EMPLOYER:

TYPE OF BUSINESS:

 

ADDRESS:

PHONE NUMBER:

 

MUNICIPALITY:

PROVINCE

POSTAL CODE:

 

NAME OF SUPERVISOR:

FOR PURPOSES OF OBTAINING EMPLOYMENT INFORMATION MAY WE CONTACT THIS EMPLOYER?             [   ] YES    [   ] NO

DUTIES/RESPONSIBILITIES:

 

 

 

REASON FOR LEAVING:

 

 

 

NAME OF EMPLOYER:

TYPE OF BUSINESS:

 

ADDRESS:

PHONE NUMBER:

 

MUNICIPALITY:

PROVINCE

POSTAL CODE:

 

NAME OF SUPERVISOR:

FOR PURPOSES OF OBTAINING EMPLOYMENT INFORMATION MAY WE CONTACT THIS EMPLOYER?             [   ] YES    [   ] NO

DUTIES/RESPONSIBILITIES:

 

 

 

REASON FOR LEAVING :

 

 

 

 

SECTION 5 (Completed by the applicant)

I confirm all of the information provided is true and accurate.  I understand that any misrepresentation may disqualify me from employment and/or cause my dismissal.  I also authorize the use of information provided on this application for obtaining employment references as indicated above.

SIGNATURE:

DATE: