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January 18, 2017
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January, 24 2014
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Client Form
Client Form
Personal Information
First Name
Last Name
Date of Birth
Social Insurance Number
Phone Number
Email
Address Line 1
Address Line 2
City
Postal Code
Major Intersection
Do you have legal right to work in Canada?
Yes
No
Status
Canadian Resident
Work Permit
Student
Study Permit Number
Work Permit Number
Do you have a drivers license?
No
Yes
G1
G2
G
A/Z
D/Z
C/F
Other
How will you get to work?
Personal Vehicle
Public Transportation
Job Preferences
Availabilty
Full Time
Part Time
Days Available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Which shifts can you work?
Day Shift
Afternoon Shift
Night Shift
Can you work overtime?
Yes
No
Can you work 12 hour shifts?
Yes
No
Please check the position you are applying for
Industrial
General Help
Packaging
Heavy Lifting
Order Picking
Skills
Shipping/Receiving
Forklift
Welding
Assembly
Office
Receptionist
Data Entry
Book Keeping
Accountant
Machine Operator
CNC
Lathe
Mould
Shear
Other Position
Other
Work History (begin with most recent)
Work Hisotry
Company Name
Title
Duties
Employed from
Employed to
Reason for leaving
Supervisor's Name
Phone Number
Work Hisotry Continued
Company Name
Title
Duties
Employed from
Employed to
Reason for leaving
Supervisor's Name
Phone Number
Education/Training
College/University
Dipolma
Specified Course
Skill Test
(5-4) + 3
11 X 9
What does WHMIS stand for?
Terms and Conditions
All employees must wear safety shoes. Shoes should be kept clean and free of any dirt and be in good condition.
Where our clients require, facemasks must be properly worn to cover the employee's nose and mouth. All employees must wear hairnets and beard nets when necessary while working in the plant. No jewelry, nail polish, false nails or false eyelashes, are to be worn in any areas of the client’s plant.
You are legally permitted to work in Canada and you are not drawing any benefits e.g. social assistance, Unemployment Insurance, which prohibits you from work.
Pay cheques are issued every week on Friday between 3:00 pm to 5:00 pm. Our office hours are from 9:00 am to 5:00 pm Monday to Friday.
Don't walk off the job. If you walk off the job you will NOT BE PAID FOR THAT DAY. If you are not satisfied with your placement, call our office immediately or at the end of the shift.
In case of an accident you MUST call our office as soon as possible. Follow this up by coming into our office within 24 hours to fill-out an accident report.
Please inform 12 hours in advance if you are not available for the next shift. If you fail to do so, you will lose pay for one day.
You will not report to the customer to be hired directly to perform the same or similar duties during or after one year working through our AGENCY for that company, therefore you will not compete against our AGENCY who has acquainted or provided the customer with manpower in the past, present, or future.
You confirm that you are in good health to perform the tasks stated in the application form.
4% vacation pay will be included in your hourly pay rate and will be paid on every pay cheque.
You agree to work more than 8 hours per day or more than 48 hours per week based on the requirement of our clients.
The information I have provided is correct to the best of my knowledge. I understand that any misrepresentation may disqualify me from employment or may cause my dismissal. I have read and I agree to abide by listed terms & conditions.
Agree to terms and conditions
Agree
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