Name (last, first) *


Day Phone *


Evening/Message Phone


Email Address *


Present Address (Street, Apt. #) *


City *


Province *


Postal Code *


Permanent Address (Street, Apt. #)


City


Province


Postal Code


Are you 18 years of age or older? *

Yes No

Position
Delivery Warehouse Sales Administration Management

Date You Can Start


Hourly Wage Expectation


Are You Employed Now?

Yes No

If so, may we inquire of your present employer ?


Have you ever worked for Furniture Villa before?

Yes No

If so, when?


Reason for leaving



Name of last supervisor



Who referred you to this company

Employment Agency Newspaper Advertisement Friend
Employment Office    College Placement Office   Web Site
Other

Subjects of Special Study or Research Work


Special Training


Special Skills

List below the last three employers starting with the most recent ones first.

Name of Present or Last Employer


Address


City


Province


Postal Code


Starting Date


Leaving Date


Job Title


Weekly Starting Salary


Weekly Final Salary


May we contact your supervisor?

Yes No

Name of Supervisor


Title


Phone


Description of Work


Reason for Leaving

Name of Previous Employer


Address


City


Province


Postal Code


Starting Date


Leaving Date


Job Title


Weekly Starting Salary


Weekly Final Salary


May we contact your supervisor?

Yes No

Name of Supervisor


Title


Phone


Description of Work


Reason for Leaving

Name of Previous Employer


Address


City


Province


Postal Code


Starting Date


Leaving Date


Job Title


Weekly Starting Salary


Weekly Final Salary


May we contact your supervisor?

Yes No

Name of Supervisor


Title


Phone


Description of Work


Reason for Leaving

Below, give the names of three persons you are not related to, whom you have known at least one year.

Name	Address	Business	Years Acquainted

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative from the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative."

Agree Disagree