<p> APPLICATION</p><p>FOR</p><p>EMPLOYMENT</p><p>Style Encore Winnipeg East B-1094 Nairn Ave Winnipeg, MB R2L 0Y4 www.style-encorewinnipegeast.com [email protected] </p><p>We at Style Encore 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 PRINT</p><p>Name ______Date ______</p><p>Present Address ______Address City Province Postal Code </p><p>Email Address (optional) SIN # (optional) ______Telephone (___) ______</p><p>Referred by ___ Advertisement ___ Agency ___ Person ___ Other ______</p><p>Are you legally entitled to employment in Canada? ___ Yes ___ No Are you between 18 and 65? ______If under 18, please state your age: ______</p><p>Position applying for ______Salary expected ______</p><p>Are you available to work ___ Full-time ___ Part-Time Specify schedule limitations ______</p><p>Date available for work ______List friends or relatives in our employ ______</p><p>Were you previously employed by us? ___ Yes __ No If yes, when ______</p><p>Other name(s) used while attending schools or places of employment indicated on this form ______</p><p>Can you perform the primary functions of this job with or without reasonable accommodation? __ Yes __ No </p><p>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.) ______</p><p>Military Service? __ Yes __ No Branch of Service and Rank ______Dates of Service______Special Training ______EDUCATION</p><p>Course Scholastic Dates of Graduated of Study Average Attendance Name and Location Yes/No Mo/Year Degree High School/GED N/A N/A College</p><p>Vocational</p><p>Other</p><p>Additional comments regarding education ______</p><p>______</p><p>______SKILLS List Computer Software Packages in which you are proficient ______What languages do you:</p><p>______speak fluently ______</p><p>Point of Sale System (cash register)______write fluently ______</p><p>Other Skills ______read fluently ______</p><p>EMPLOYMENT HISTORY (List present or most recent employer first) Name of Company ______Address ______</p><p>Supervisor ______Salary ______Phone ______</p><p>Job Title ______Date Started ______Date Left ______</p><p>Job Description ______</p><p>______Reason for Leaving:</p><p>Name of Company ______Address ______</p><p>Supervisor ______Salary ______Phone ______</p><p>Job Title ______Date Started ______Date Left ______</p><p>Job Description ______</p><p>______Reason for Leaving:</p><p>Name of Company ______Address ______</p><p>Supervisor ______Salary ______Phone ______</p><p>Job Title ______Date Started ______Date Left ______</p><p>Job Description ______</p><p>______Reason for Leaving:</p><p>Name of Company ______Address ______</p><p>Supervisor ______Salary ______Phone ______</p><p>Job Title ______Date Started ______Date Left ______</p><p>Job Description ______</p><p>______Reason for Leaving: AUTHORIZATION FOR BACKGROUND CHECK: I authorize [insert name of employer] to verify employment, except as noted below, as well as conduct criminal and vehicular record check.</p><p>Indicate those you do not wish contacted:______</p><p>Signed: ______Date: ______REFERENCES Please list three persons other than relatives or personal friends, who can judge your work ability.</p><p>1) Name ______Occupation ______</p><p>Address ______Phone ______</p><p>2) Name ______Occupation ______</p><p>Address ______Phone ______</p><p>3) Name ______Occupation ______</p><p>Address ______Phone ______</p><p>Please use the space provided below to summarize any additional information necessary to fully describe your qualifications.</p><p>______</p><p>______</p><p>______</p><p>______</p><p>*** PLEASE READ ***</p><p>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 [insert name of employer] to investigate past employment and education history, as well as references.</p><p>I fully understand and agree to all statements above.</p><p>______Signature Date</p><p>OFFICE USE ONLY</p><p>Interviewed by ______Date ______</p><p>Referral Source ______Hired ______Not Hired ______</p><p>Starting Date ______Position ______Salary ______</p><p>Location ______Reporting To ______</p>