Nipissing University and Canadore College Student Centre

Student Centre Employment Application

Personal Information (All fields marked with * are required)

First Name:*

Last Name:*

Mailing Address:*

Apt #:

City:*

Prov:*

Postal Code:*

Home Ph:*

Other Ph:

Mobile Ph:

Email Address:

Date available to begin work:

Desired Location:

Position Applying for:

Position Type:

Please answer the following questions

Are you legally entitled to work in Canada?*

Yes No

Are you 18 years of age or older?*

Yes No

Do you have a Social Insurance Number?*

Yes No

Do you hold a valid driver's license?*

Yes No

Are you willing to work split shifts?*

Yes No

Are you available to work?*

Summer School Year Both

Do you have access to transportation past 11:00 PM?*

Yes No

Employment History (Most current first)

Employer/Company:

City:

Position/Title:

Supervisor:

Start:

End:

Duties:

Reason for Leaving:

Employer/Company:

City:

Position/Title:

Supervisor:

Start:

End:

Duties:

Reason for Leaving:

Employer/Company:

City:

Position/Title:

Supervisor:

Start:

End:

Duties:

Reason for Leaving:

Digital File Attachment (Must be a Microsoft Word Document or PDF Document)

Attach Resume:
Attach Cover Letter:

Applicant's Agreement

I agree that any misrepresentation on this application form or on employer documents completed after my hiring may be cause for refusing to employ me or dismissal. I consent to the company making its usual inquiries about my work experience through my former employment and to the obtaining of consumer reports that may contain credit and personal information other than that of a religious, racial or ethnic character.

By checking this box, you are conveying the same privilege as your signature: