Full Name

Mail Address

City

Province

Postal Code

Phone

Email

S.I.N.

Are You Presently Employed?      Yes     No

If so, provide Employer's (supervisor) name, address and phone number in the box below.

List your educational background. Include school/institution, course of studies, years, and graduation date:

Do you speak any other languages? Yes     No If so, list languages spoken.

Other Languages Spoken:

Do you have any experience dealing with the public? Yes    No

Have you any special training or work experience?  If so, explain fully:

Why would you like to work at Hendrix Condon Barr?

If you were to be hired detail below what date you would be available to start:

Start Date:

Please list former employers, starting with the last one first:

Employer: Start / End dates: Address: Phone: Postion held: Supervisor: Reason for Leaving: Employer: Start / End dates: Address: Phone: Postion held: Supervisor: Reason for Leaving: Employer: Start / End dates: Address: Phone: Postion held: Supervisor: Reason for Leaving: Employer: Start / End dates: Address: Phone: Postion held: Supervisor: Reason for Leaving:

In 100 words or less, give an outline of any special interests, activities or functions your participate in:

Personal References (1 Reference minimum; Maximum of 3)

Name and Occupation

Address

Telephone

Name and Occupation

Address

Telephone

The facts set forth above in my application for employment are true and correct. I understand that, if employed, false statements on this application shall be considered sufficient cause for dismissal. *Criminal Record Checks will be required prior to employment