Cuddy Farms Employment Application
Personal Information			Date
Name
	Last		First		Middle
Present Address
		Street		City	Prov.	Postal Code
Permanent Address
		Street		City	Prov.	Postal Code
Phone
Are You Related to Anyone In Our Employ?				Yes	No	If yes, who?
Have You Ever Been Employed By Cuddy Farms?					Yes	No
If yes, where?			Who was your supervisor?
Were you referred by an employee of Cuddy Farms?						Yes No
If yes, please give employee's name.
At Your Place Of Residence, Is There Poultry, Pet Birds, or Pigs?						Yes No
Are you legally entitled to work in Canada?						Yes No
Employment Desired			Full-time		Part-time		Summer
Position			Start Date			Salary
Have you ever been convicted of a criminal offence for which you have not been pardoned? Yes No
Employment History
Former Employers		List Below, Starting With Last One First
Employer					Dates	Salary	Position Held
Name					From
Address							Reason For Leaving
City Prov. P.C.					To
Phone #		Contact Person
Employer					Dates	Salary	Position Held
Name					From
Address							Reason For Leaving
City Prov. P.C.					To
Phone #		Contact Person
Employer					Dates	Salary	Position Held
Name					From
Address							Reason For Leaving
City Prov. P.C.					To
Phone #		Contact Person
Employer					Dates	Salary	Position Held
Name					From
Address							Reason For Leaving
City Prov. P.C.					To
Phone #		Contact Person
Education
		Name & Location of School			Years	Did You	Major
					Attended	Graduate?
High School						Yes No
College						Yes No
Other Studies						Yes No
Are there any other experiences, skills, or qualifications which you feel would especially fit you for work with us?
References	Give Below the Names of Three Persons Not Related To You, Whom You Have Known At Least One Year.
	DO NOT USE REFERENCES OF A RELIGIOUS OR ETHNIC NATURE
Name			Address			Business		Telephone
1.
2.
3.
I authorize investigation of all statements contained in this application. I understand that
misrepresentation or omission of facts called for is cause for dismissal. Further I
understand and agree that my employment is for no definite period.
Date				Signature
	DO NOT WRITE BELOW THIS LINE
Interviewed By						Date