Job Seeker Application Form

Your Availability *

Weekdays

Weekends

Evenings

First Name *

Last Name *

Address

Province

City

Postal Code

Phone Number *

Email Address *

SIN#

Birth Date

Gender:

Do you have an insured vehicle?

Do you have a valid driver's license?

Have you worked with an employment agency before?

If so, which companies?

Where were you assigned to work?

Experience

If you have experience in any of the following trade, please indicate your years of experience in the spaces below:

Other Trade not listed

Are you available for general labour?

Safety Training

WHMIS

H2S

Confined Space

Transportation of Dangerous Goods

CPR

Forklift Certificate

Food Safe

OFA

Other

Equipment List

Reflective Vest

Safety Glasses

Steel Toed Boots

Work Gloves

Steel Toed Rubber Boots

Coveralls

Hard Hat

Fire Retardant Coveralls

Safety Issues

Have you ever submitted a WCB Claim?

Do you have any concerns about working with heights?

Do you have any concerns about working with chemicals?

Do you have a history of back problems?

Do you have any concerns about lifting heavy weights?

Other Medical Concerns

Work ReferencesReference 1

Reference 2

Do you have a criminal record?

Have you ever had a criminal record check done?

Emergency Contact *

Medical Emergency Information

This medical information is requested for the purposes of assisting us in placing you within a position suitable to your capacity and therefore minimizing the risk of serious injury to yourself, your fellow workers and/or the public.

Have you ever had a head injury?

Do you have dizzy or fainting spells?

Have you ever had a hearing problem?

Have you had any previous fractures?

Do you have a heart condition?

Do you have any allergies?

Do you have any respiratory problems?

Are you taking medications at the present time?

Are you medically cleared and fit to work with no restrictions or disabilities from any previous injury, illness, or medical condition?

Is there any other pertinent medical illness, or injury related Information you feel we should be aware of?

Do you have epilepsy?

Do you have diabetes?

Have you had a previous eye injury?

Have you had a previous injury to any major joints i.e. ankle, knees, hip, elbow, shoulder?

Do you have high blood pressure?

Have you ever had any back problems?

Do you have a hernia?

Have you seen a physician for any illness, injury, or surgery in the past year?

I the undersigned duly declare the above information to be accurate and correct to the best of my knowledge. I understand that any omissions or misrepresentations may result in reclassification or dismissal upon review by my employer. I further authorize my employer to obtain a medical evaluation by a physician if required.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OR OMISSIONS OF FACT IS CAUSE FOR DISMISSAL. FUTHER, I UNDERSTAND AND AGREE THAT MY EMPLOYMENT IS NOT NECESSARILY FOR A DEFINITE PERIOD.

I HAVE READ LABOUR UNLIMITED TEMPORARY SERVICES WORKSAFE POLICY AND UNDERSTAND MY RIGHTS AND AGREE TO COMPLY WITH THE REGULATIONS OUTLINED UNDER THE WSIB Act ANDTHE OCCUPATIONAL HEALTH & SAFETY ACT.

By typing my name and the date below, I agree to the above terms.

I consent to Labour Unlimited contacting me regarding employment *

Thank you! Your submission has been received!

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