Vera's Employment
Application Form
INSTRUCTIONS: To apply for employment with Vera's Burger Shack,
please complete ALL text fields and Fax it to: 604-683-8374
Contact Information
Name in Full: (please print)
Date:
Permanent Address (Street/City/Prov)
 Postal Code
E-mail Address
 Social Insurance Number
Telephone Number
 Cell Phone or Other Number
Date Available to Start
 Who referred you to us?

Employment Information
Are you legally entitled to work in this country? Yes: No:
Are you of legal working age? Yes: No:
Do you have your "Serving It Right" card? Yes: No:
Do you have a "Food Safe" certificate? Yes: No:
Do you have transportation? Yes: No:
Are there any days or shifts you can't work? Yes: No:
How many shifts a week do you wish to work?
Are you available for more? Yes: No:
Have you previously been employed by us? Yes: No:
If Yes, when and location?

Education Information
Name & location of school:
Date From/To:
Major:
Certificates/Diplomas
High School:
Vocational:
College/University:
Special Qualifications:
Special Qualifications:
Outside Interests :
(excluding racial, religious and political groups)
Names of friends and relatives working with us:

Employment History

Company Name:
Phone Number:
Supervisor's Name:
From Mo/Yr:
To Mo/Yr:
Starting $:
 Ending $:
Description of Duties:
Company Name:
Phone Number:
Supervisor's Name:
From Mo/Yr:
To Mo/Yr:
Starting $:
 Ending $:
Description of Duties:
Company Name:
Phone Number:
Supervisor's Name:
From Mo/Yr:
To Mo/Yr:
Starting $:
 Ending $:
Description of Duties:

References

#1 Reference Name:
Phone Number:
Relationship:

#2 Reference Name:
Phone Number:
Relationship:
If you have no previous employers please supply us with references other than family and that do not indicate religious affiliation or ethic origin.

Emergency Contact Information
Please supply details of whom we should contact should there be a medical emergency at work.
Name:
Phone Number:
Relationship:
Use this space to give us any relevant information that may help us determine the best job for you.
I certify that the information presented on this Employment Application is true and I understand that any misrepresentation or material omission will be grounds for dismissal. I consent to this company making it's usual inquiries about my work experience and relevant personal information.

Date:
Name/Signature:
For Use by Vera's Burger Shack
Date:
Interviewed By: Date: 2nd Interview By:

Vera's Burger Shack is committed to non-discrimination and equal opportunities in its employment, education programs, activities regardless of race, color, creed, religion, sex, sexual orientation, national origin, ancestry, age, disability or status and shall take action necessary to ensure non-discrimination.