THE BURGER SHACK

Employment Application
Applicant Information
Full
Name: Date:
Last First M.I.

Address:
Street Address Apartment/Unit #

City State ZIP Code

Phone: Email

Date Social Insurance

Available: No.:

Position Applied
for:

YE
YES NO S NO
Are you a Canadian Citizen? If no, are you authorized to work in Canada?

YES NO
Have you ever worked for this company? If yes, when?

Have you ever been convicted of a YES NO

felony?

If yes,
explain:

Education
Address
High School: :

Did you YES NO Diploma

From: To: graduate? :

Colleg Address
e: :

Did you YES NO

From: To: graduate? Degree:

Address
Other: :

Did you YES NO

From: To: graduate? Degree:

References
Please list three professional references.
Full Relationship:
1
Name:
Company
: Phone:
Address:
Full
Name: Relationship:
Company
: Phone:
Address:
Full
Name: Relationship:
Company
: Phone:
Address:

Previous Employment
Company
: Phone:
Supervisor
Address: :

Job Title: Starting Salary: $ Ending Salary: $

Responsibilitie
s:

To
From: : Reason for Leaving:

May we contact your previous supervisor for a YES NO

reference?

Company
: Phone:
Supervisor
Address: :

Job Title: Starting Salary: $ Ending Salary: $

Responsibilitie
s:

To
From: : Reason for Leaving:

May we contact your previous supervisor for a YES NO

reference?

Company
: Phone:
Supervisor
Address: :

2
 Job Title: Starting Salary: $ Ending Salary: $

Responsibilitie
s:

To
From: : Reason for Leaving:

May we contact your previous supervisor for a YES NO

reference?

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or
interview may result in my release.
Signature
: Date: