Star Van Systems Inc.

Request for Employment
Personal Information
Date Available	(dd/mm/yyyy)
Name
Address
City
Province		Postal Code
Phone Number		Email
Birthdate		S.I.N.
Emergency Contact		Contact Phone
Former Employers
1st Company		2nd Company
From/To		From/To
Salary		Salary
Position		Position
Reason for leaving		Reason for leaving

3rd Company		4th Company
From/To		From/To
Salary		Salary
Position		Position
Reason for leaving		Reason for leaving
References
1st Reference Name		Phone Number	Years Known
2nd Reference Name		Phone Number	Years Known
3rd Reference Name		Phone Number	Years Known
Additional Comments

Disclaimer: I certify that all the information entered into this form is true and correct. I give permission to Star Van Systems Inc. to perform a complete background check in accordance with Provincial and Federal laws. Furthermore, I authorize all my previous employers to release any information requested by Star Van Systems Inc. and I hold them harmless of all liability resulting from the release of information. I also understand that if I am a qualified applicant I will be considered for all positions without regard to race, religion, sex, colour, national origin, marital status, age or any non-job related disability in accordance with Federal and Provincial laws. I agree to this disclaimer by pushing the Submit Form Button.