Employee Application

APPLICANT INFORMATION:

Full Name:
First Last
Address:
Street Address Unit #

City State Postal Code

Home Phone: ( ) Cell Phone: ( )

E-mail Address:

While my preference is to work at the _______________________ location, I am available to work at all locations as
needed.

What is your preferred location?

Please check all that apply: Coquitlam Kitsilano North Vancouver

I understand that this availability may only change after giving notice to the manager and receiving their approval and
cannot change within the 3 month probationary period

FULL-TIME APPLICANTS:

Date available: Are you going back to school? Yes No Start date:______

I understand I am applying for a full-time job that requires open availability: Yes No

PART-TIME APPLICANTS:
Are you going back to school? Yes No Start date:______
Date available:

The average numbers of hours per week I would like to work is ___________.

I am available to work as follows: I am available any time every day

1. Mondays: ____ am - ____ pm or Available Any Time or Not Available

2. Tuesdays: ____ am - ____ pm or Available Any Time or Not Available

3. Wednesdays: ____ am - ____ pm or Available Any Time or Not Available

4. Thursdays: ____ am - ____ pm or Available Any Time or Not Available

5. Fridays: ____ am - ____ pm or Available Any Time or Not Available

6. Saturdays: ____ am - ____ pm or Available Any Time or Not Available

7. Sundays: ____ am - ____ pm or Available Any Time or Not Available

CERTIFICATIONS:

Highest level or grade Type of certificate or

completed: diploma obtained:

Do you have Driver’s license? Yes No DL Class ________________,

Are you legally entitled to work in Canada? Yes No
I am able to lift 40lbs repetitively: Yes No
 Employee Application

REFERENCES:

Please list three professional references or attach on separate sheet.

Full Name Relationship
1
Company Phone

Full Name Relationship

2
Company Phone

Full Name Relationship

3
Company Phone

PREVIOUS EMPLOYMENT:
Company Phone

Address Supervisor

Job Title Starting Salary $ Ending Salary $

1
Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a
Yes No
reference?
Company Phone

Address Supervisor

Job Title Starting Salary $ Ending Salary $

2
Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a
Yes No
reference?

My signature below certifies that:

 All information in this application for employment is correct and complete to the best of
my knowledge and belief.
 I understand that false or misleading information in this application could result in refusal
of employment or discharge.
 I authorize the verification of the above information and any other necessary inquiries that may
be needed to determine my suitability for employment.
 I authorize KORNA Pet to contact any of the references provided by me for the purpose of a
reference check.
 I understand that this application for employment does not constitute an employment offer.

Signature: ________________________________________________ Date: ___________________