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NOTE TO APPLICANT:
All information is treated as strictly confidential and subject to investigation. This form must be fully filled in and will be used to evaluate your suitability for employment ALL QUESTIONS MUST BE ANSWERED FULLY
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Are you seeking?
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Employment not to extend beyond:
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Are you between the ages of 16 & 65
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Are you legally entitled to work in Canada?
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First Name
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Last Name
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Middle Name
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Street Address
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City/Town
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Major Intersections
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Postal Code
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Email Address
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Home Telephone Number
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Business Telephone
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Place of residence for the past (10) years excluding present address
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Address - Street / Apt No.
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City
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Prov/State/Country
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From
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To
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Do you own a motor vehicle?
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Do you have regular use of a motor vehicle?
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Do you have a valid driver’s license?
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If Yes... list class(es)
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If you are applying for full time employment, can and will you work full rotating (any time day and night) shifts and Weekends?
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If no, give reason
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If you are applying for a part time position, list which days and times you will be available to work:
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If you are applying for a part time position, can and will you commit to working assigned shifts every week?
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Can and will you work at any location in the Greater Toronto Area?
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How did you hear of us?
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Specify
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If you are presently employed, why do you wish to leave?
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EMPLOYMENT RECORD
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LIST YOUR EMPLOYMENT HISTORY STARTING WITH YOUR CURRENT/MOST RECENT EMPLOYMENT
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Employer’s Name
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Start Date
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End Date
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Address
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Type of Business
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Telephone Number
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Position Held
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Final Salary
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Supervisor’s Name
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Reason for Leaving
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Briefly Describe Your Responsibilities
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Employer’s Name
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Start Date
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End Date
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Address
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Type of Business
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Telephone Number
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Position Held
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Final Salary
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Supervisor’s Name
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Reason for Leaving
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Briefly Describe Your Responsibilities
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Employer’s Name
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Start Date
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End Date
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Address
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Type of Business
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Telephone Number
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Position Held
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Final Salary
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Supervisor’s Name
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Reason for Leaving
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Briefly Describe Your Responsibilities
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Employer’s Name
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Start Date
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End Date
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Address
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Type of Business
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Telephone Number
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Position Held
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Final Salary
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Supervisor’s Name
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Reason for Leaving
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Briefly Describe Your Responsibilities
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PERSONAL REFERENCES
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List two people, other than former/current employers, co-workers or family, to whom we may refer to in confidence.
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NAME
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ADDRESS
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OCCUPATION
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PHONE NUMBER
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YRS KNOWN
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In the event of an emergency, who is to be notified?
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Name
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Address
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City/Town
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Telephone
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Have you ever been employed by Reilly’s Security?
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IF yes, please list location, position and dates:
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Do you have or have you had any relatives in our employment?
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If yes, please give their names and their relationship to you.
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Minimum starting wage expected?
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PER |
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Date available to start work:
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Can and will you work overtime if required?
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Have you ever been convicted or found guilty of an offence under the laws of any country, province or state?
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If yes, list the details below:
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OFFENCE
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DATE
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PLACE
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POLICE DEPT.
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SENTENCE
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Is or has your driver’s licence been under suspension?
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If yes, give details:
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Have you ever been bonded?
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If yes, give details:
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EDUCATION
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Secondary School Name
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Number of Years
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Last Grade Completed
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Year Completed
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Course of Study
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College/University Name
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Number of Years
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Last Year Completed
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Degree Obtained
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Course of Study
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Business/Trade School
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Number of Years
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Last Year Completed
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Diploma Obtained
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Course of Study
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LIST ANY SPECIAL TRAINING OR SCHOOLING LISTING CERTIFICATES / DIPLOMAS
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SKILLS – Please list the training and or experience you have in the following categories
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TRAINING
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EXPERINCE
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TRAINING
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EXPERINCE
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W.H.M.I.S
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YES NO |
YES NO |
Self Defense - List
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YES NO |
YES NO |
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C.P.R. - Basic Rescuer
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YES NO |
YES NO |
Typing/Keyboarding
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YES NO |
YES NO |
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C.P.R. - Heartsaver
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YES NO |
YES NO |
Handcuffing
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YES NO |
YES NO |
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First Aid - Emergency
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YES NO |
YES NO |
Use of Force - Specify
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YES NO |
YES NO |
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First Aid - Advanced
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YES NO |
YES NO |
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Computer – List Courses/Programs and Experience
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Others (Give Details)
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Are you fluent in English?
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Are you fluent in French?
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Other(s)
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List Others
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Have you ever been fired, discharged, terminated or asked to resign?
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If yes, list companies, dates, and circumstances
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May we contact your present employer?
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May we contact your previous employers?
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- I declare that, to the best of my knowledge, all of the information contained in this application is accurate, complete and true. I Authorize Reilly’s Security Services (“RSS”) to verify all information contained on this application, including conducting credit references and verifying employment history with third parties. I understand that any false statements shall be sufficient reason to disqualify me from employment and constitute just cause to preclude me from continued employment, if I am employed.
- If I am employed, I agree to maintain confidential all information, procedures, policies and other matters pertaining to RSS, its clients and employees. I also agree that failure to comply with this requirement will result in disciplinary action up to and including termination of employment.
- If I am employed by RSS, I agree to abide by the Conditions of Employment (as amended from time to time), a copy of which I will be given to read and sign prior to starting employment. I also agree to abide by and follow all posted orders, instructions, and regulations. I acknowledge and agree that failure to comply with the above provisions will result in disciplinary action up to and including termination of employment for just cause.
- I acknowledge and agree that I have fully disclosed and not misrepresented my ability to comply with the conditions of my employment, including but not limited to my ability to work anywhere in the Municipality of Toronto and the Greater Toronto Area (“GTA”); and to work regularly rotating shifts, as assigned by the employer. I further acknowledge and agree that misrepresentation of my ability to meet, or failure to comply with the conditions of my employment may result in disciplinary action up to and including termination for just cause.
- If I am employed by RSS, I agree to produce acceptable evidence of my immunization status or to obtain and maintain an immunization status, acceptable to RSS if required.
- I acknowledge and agree that if employed, my employment may be terminated at any time and from any position held, by the provision of notice, termination pay or severance pay or any other payment as prescribed by the Employment Standards Act and that shall be my full and final entitlement upon termination.
- I acknowledge and agree that the first ninety days of my employment are probationary and that my employment may be terminated during this period at the full discretion of RSS without cause or notice to me. I also acknowledge and agree that my probation period may be extended, at the full discretion of RSS, at any time.
I have carefully read the above, understand the terms of this application form and agree to abide by them.
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