Calgary Co-op Employment Application

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Personal Information
Family Name
 First Name
Address  (No., Street, Apt. No., City, Province, Postal Code)
Home Telephone
() -  ext.
Business Telephone
() -  ext.
Email Address
 
 
Are you 15 years of age or older?
 
 
Family or friends at Calgary Co-op?
Name(s)
 
 
Have you worked for Calgary Co-op before?
If yes, when? (day/month/year)

From:  
    To:  
 
 
Have you ever been discharged from any position?
If yes, explain in additional information/comments section below.
 
 
Have you ever been convicted of an offence(s), for which you have not received an unrevoked pardon, under the Criminal Code, the Food & Drug Act or Narcotic Control Act?
If yes, explain in additional information/comments section below.
 
 
Do you have any illness, disability or physical limitations which may prevent you from regularly lifting or carrying 10kg?
 
 
Are you legally entitled to work in Canada?
If on temporary work permit, what is the expiry date?
(day/month/year)
 
 
Do you have any illness, disability or physical limitations which may prevent you from doing work of a repetitive nature?
Job Interest
(Calgary Co-op Locations):
N.W.

Brentwood

Creekside

Crowfoot

Dalhousie

Hamptons

Montgomery Gas Bar

Rocky Ridge
N.E.

Beddington

Monterey

North Hill

Taradale

Village Square
S.E.

Copperfield Gas Bar

Deer Valley

Downtown Gas Bar

Eastfield Gas Bar

Forest Lawn

Heritage Town Centre Gas Bar

Macleod Trail

Quarry Park

South Trail Crossing
S.W.

Kingsland Gas Bar

Oakridge

Midtown Market

Richmond Road

Shawnessy

West Springs
Other Communities:
Airdrie
 
Okotoks Gas Bar
 
Strathmore
 
Head Office:
Head Office
 
Type of work
1.
2. 		Preference for
 
 
Date available: (day/month/year)
 Rate of pay expected:
 Who referred you to Calgary Co-op?
Availability  (Specify for 24 hour period. Retail hours range from 5am to 11pm.)
HOURS
AVAILABLE 		Sunday Monday Tuesday Wednesday Thursday Friday Saturday
FROM » 
TO » 
Education  (Highest level achieved)
HIGH SCHOOL From (day/month/year)
 Name
  To
 Location  
   
 
 
 Grade
 Achieved required credit or diploma
yes
COLLEGE, UNIVERSITY, BUSINESS, TRADE OR
OTHER SCHOOL 		From (day/month/year)
 Name
To
 Location  
  Specify degree or diploma attained  
Personal References
Give three personal references who have known you well during the last five or more years excluding relatives and former employers. (you may decline to list ministers of religion)
Name
(include first name or initials) 		Address
(No., Street, Apt. No., City, Province, Postal Code) 		Telephone
(include area code) 		Years Known Present or most recent occupation
Employment History
  Check the number of any employer that you do not want us to contact at this time.
1
   
2
   
3
1. Company Name
 Telephone #
()
  Address  (No., Street, Apt. No., City, Province, Postal Code)
  Type of Business

Position
  
 
  		Salary Start

Final
 Employed From: (day/month/year)

To:
  Nature of duties from start to time of leaving (give title, responsibility, supervisory experience, etc.)
  Were you a supervisor?
     

# of people supervised  		Reason for leaving
 Immediate Supervisor
Name

Title
2. Company Name
 Telephone #
()
  Address  (No., Street, Apt. No., City, Province, Postal Code)
  Type of Business

Position
  
 
  		Salary Start

Final
 Employed From: (day/month/year)

To:
  Nature of duties from start to time of leaving (give title, responsibility, supervisory experience, etc.)
  Were you a supervisor?
     

# of people supervised  		Reason for leaving
 Immediate Supervisor
Name

Title
3. Company Name
 Telephone #
()
  Address  (No., Street, Apt. No., City, Province, Postal Code)
  Type of Business

Position
  
 
  		Salary Start

Final
 Employed From: (day/month/year)

To:
  Nature of duties from start to time of leaving (give title, responsibility, supervisory experience, etc.)
  Were you a supervisor?
     

# of people supervised  		Reason for leaving
 Immediate Supervisor
Name

Title
Other Time      
Account for your time during any interval of unemployment other than when you were attending school. You may decline to list any illnesses or leaves of absence relating to disability.
From (day/month/year)

To

 Explanation
From (day/month/year)

To

 Explanation
Additional Information/Comments
Application Statement

I understand that the personal information on this form is being collected for the purpose of establishing and maintaining an employment relationship and may be disclosed without my further consent within Calgary Co-operative Association Limited. The personal information will not be disclosed to any third party, other than for the purpose of verifying my employment, without my consent. By signing below I am consenting to the collection, use and disclosure of this information by Calgary Co-operative Association Limited for the purposes stated. I understand that if this application does not result in employment with Calgary Co-operative Association Limited, that the application and personal information contained herein will be retained for six months and then destroyed.

In signing this application, I understand that any misrepresentation or omission of facts is cause for cancellation of this application or termination of employment. I hereby consent to have an investigation of work and personal references, security check, and a credit investigation conducted.
Signature of applicant
 Date