Clerical Application – Task Carriers

Personal Information

Position applied for*

Temporary
Part Time
Full Time

Name*

First Middle Last

Phone

Current Address

Street Address City Province Postal Code

Address for past 3 years

Other addresses you have lived in for the past 3 years

Street Address City Province Postal Code

Address for past 3 years

Other addresses you have lived in for the past 3 years

Street Address City Province Postal Code

Have you ever been convicted of a crime for which a pardon has not been granted?

Yes
No

Who referred you?

Rate of pay expected?

Have you worked for this company before?

Yes
No

Date: From

Date: To

Where?

Rate of Pay

Position

Reason for Leaving?

Name of any relatives employed by this company?

Are you currently employed?

Yes
No

If not, how long since leaving last employment?

Education

Highest Education Completed: High School Grade:

College Years:

Last School attended?

Last school address:

Physical History

List any handicap that prevents you from doing certain kinds of work.

Are you physically capable of heavy manual work?

Yes
No

Ever injured on the job?

Yes
No

If yes, give the nature and degree of such injuries

How much time lost from work in the past three years for illness?

Will you be willing to take a physical examination?

Yes
No

Clerical Experience

List courses and training in office work

Indicate training and experience in the following when applicable

Shorthand (wpm)

Formal Training

Shorthand (wpm) Years of Experience

Billing

Formal Training

Billing Years of Experience

Filing

Formal Training

Filing Years of Experience

Computers (indicate software on right)

Formal Training

Indicate Software and Years of Experience

Software	Years of Experience

Word Processing Equipment

Formal Training

Word Processing Equipment Years of Experience

Key Punch

Formal Training

Key Punch Years of Experience

Calculator

Formal Training

Calculator Years of Experience

Adding Machine

Formal Training

Adding Machine Years of Experience

Telecopier

Formal Training

Telecopier Years of Experience

Photocopier

Formal Training

Photocopier Years of Experience

Bookkeeping Machine

Formal Training

Bookkeeping Machine Years of Experience

Switchboard Equipment

Formal Training

Indicate Switchboard Type and Years of Experience

Type	Years of Experience

Tabulator

Formal Training

Tabulator Years of Experience

Accounting

Formal Training

Accounting Years of Experience

OS & D

Formal Training

OS & D Years of Experience

Interline

Formal Training

Interline Years of Experience

Claims

Formal Training

Claims Years of Experience

Cashier

Formal Training

Cashier Years of Experience

Dispatcher

Formal Training

Dispatcher Years of Experience

Rates (indicate tariffs with which you have worked)

Employment History

Start with last or current position, including military experience, and work back.

Last Employer

Supervisor’s Full Name:

Full Address

Postal Code

Phone

Position Held:

Enter the position held

From:

Month/Year

To:

Month/Year

Salary

Reason for Leaving:

Second Last Employer

Supervisor’s Full Name:

Full Address

Postal Code

Phone

Position Held:

Enter the position held

From:

Month/Year

To:

Month/Year

Salary

Reason for Leaving:

Third Last Employer

Supervisor’s Full Name:

Full Address

Postal Code

Phone

Position Held:

Enter the position held

From:

Month/Year

To:

Month/Year

Salary

Reason for Leaving:

APPLICANT MUST READ AND SIGN

I certify that I have read and understood all of this employment application. It is agreed and understood that the employer may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not, and I release employers and other persons named herein from all liability for any damages on account of furnishing such information.

I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks, which are pertinent to the job. I also understand that if offered a job, it may be conditional on the results of a physical examination and drug test. I certify that I am genuine for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason. If hired, I agree to abide by all the rules and policies of the employer.

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

Applicant Signature*

Type in your signature

Sign Date*

Enter the sign date

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