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Applicant Information

Last Name

First Name

Middle Initial

Address (P.O Box / Street Address)

Apartment/Unit #

City

Province - SELECT -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukon

Postal Code

Phone

Email

Date Available

Are you legally authorized to work in Canada?

YesNo

Are you between the ages of 18 and 64?

YesNo

Are you able to work Saturdays?

YesNo

Have you ever worked for Kroeker Farms Limited?

YesNo

If yes, when?

Have you been referred by a Kroekers employee?

YesNo

If yes, who? (Limit of 1 name)

Please indicate the highest level of education you have attained: Grade School EducationHigh SchoolUniversity/College

Did you graduate?

YesNo

Degree/Diploma earned:

Previous Employment

Employer #1

Company

Phone

Address

Supervisor

Responsibilities

Start Date

End Date

Reason for Leaving

May we contact your previous supervisor for a reference?

YesNo

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Employer #2

Company

Phone

Address

Supervisor

Responsibilities

Start Date

End Date

Reason for Leaving

May we contact your previous supervisor for a reference?

YesNo

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Employer #3

Company

Phone

Address

Supervisor

Responsibilities

Start Date

End Date

Reason for Leaving

May we contact your previous supervisor for a reference ? YesNo

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How did you find out about us (Other)

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

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