Employment Application Page 2

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EMPLOYMENT HISTORY
Name of current or most recent employer
Employed
Position / Duties
From
To
Mo
Yr
Mo
Yr
Address / Location
Telephone
Supervisor
Salary / Wage
Reason for leaving
May we contact the employer named above?
Yes
No
Name of previous employer
Employed
Position / Duties
From
To
Mo
Yr
Mo
Yr
Address / Location
Telephone
Supervisor
Salary / Wage
Reason for leaving
May we contact the employer named above?
Yes
No
Name of previous employer
Employed
Position / Duties
From
To
Mo
Yr
Mo
Yr
Address / Location
Telephone
Supervisor
Salary / Wage
Reason for leaving
May we contact the employer named above?
Yes
No
Name of previous employer
Employed
Position / Duties
From
To
Mo
Yr
Mo
Yr
Address / Location
Telephone
Supervisor
Salary / Wage
Reason for leaving
May we contact the employer named above?
Yes
No
PLEASE READ CAREFULLY BEFORE SIGNING
Personal information collected in the recruitment process, which may include job applications, questionnaires or personal interviews,
is for the purpose of determining your suitability for employment. I hereby certify that the facts set forth in the recruitment process
are true and complete to the best of my knowledge. I understand that if employed, falsified statements shall be considered sufficient
cause for termination.
If employed, I give consent to Home Hardware Stores Limited to retain the information obtained through the recruitment process on
my employee personnel file and consent to the use of my personal information for the administration of my employment. I authorize
Home Hardware Stores Limited to check references with my previous employers and references provided. I hereby release the
employer and reference from any liability arising out of the reference, which is to be provided
Date: _______________________________________ Signature of Applicant: __________________________________________
Have you ever been convicted of a criminal offense for which a pardon has not been granted?
Yes
No
At Home Hardware Stores Limited we understand the importance of your personal privacy. We have instituted policies and
procedures to ensure that any personal information that you provide to us is protected.
We will accommodate the needs of qualified applicants under the Human Rights Code in all parts of the hiring process.

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