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Online Application

Please complete the following Peninsula Co-op employment application form.

*First Name
 
*Last Name
 
Email Address
someone@domain.com  
Confirm Email Address
 
*Phone Number
(555)-555-5555  
*Address
 
*City
 
*Province
*Postal Code
V8V 8V8  
*Are you at least 15 years of age?
*Are you legally entitled to work in Canada?
*Do you have a disability or condition that will affect your ability to perform any function of the job for which you have applied?
What is your means of transportation to work?
*Have you worked for Peninsula Co-op or Save-On Gas previously?
*Please provide the name of the location and the approximate dates you were employed for Peninsula Co-op or Save-On Gas.
*Do you know someone who works for Peninsula Co-op or used to work for Peninsula Co-op in the past?
Please specify their names
If you were referred to us by a Peninsula Co-op employee please provide the name of that employee:
*What date are you available to start work?
*How many hours are you interested in working each week?
Please indicate your availability:
I am available:
From:
To:
Monday
-
Tuesday
-
Wednesday
-
Thursday
-
Friday
-
Saturday
-
Sunday
-
Education
*Are you presently attending school?
High school attended
*Last grade completed
*Did you graduate?
College/University attended
Last year completed
Did you graduate?
Degree/diploma received
Please list any special certifications or qualifications.
Employment History
Name of current or most recent employer
Type of Business
Address
Job Title
Start date
End date
Reason for leaving
Supervisor Name
Supervisor Phone Number
(555)-555-5555  
May we contact this employer for a reference?
Name of employer
Type of Business
Address
Job Title
Start date
End date
Reason for leaving
Supervisor Name
Supervisor Phone Number
(555)-555-5555  
May we contact this employer for a reference?
Name of employer
Type of Business
Address
Job Title
Start date
End date
Reason for leaving
Supervisor Name
Supervisor Phone Number
(555)-555-5555  
May we contact this employer for a reference?
Please explain any gaps of 3 months or more in employment.
Volunteer History
Please list your volunteer experience.
List any Co-op background, interests, extracurricular activities, sports, special skills such as equipment operations, languages spoken/written, computer skills, academic honors, scholarships, etc. (You may decline to list any organizations that would depict your race, religion, ancestry, or disabilities.)
References
*Name
Email Address
someone@domain.com  
Address
*How do you know this person?
*Phone
(555)-555-5555  
Name
Email Address
someone@domain.com  
Address
How do you know this person?
Phone
(555)-555-5555  
Name
Email Address
someone@domain.com  
Address
Phone
(555)-555-5555  
How do you know this person?
Cover Letter and Resume
Attach cover letter
.pdf, .doc, .docx only.  
Attach resume
.pdf, .doc, .docx only.  
Acknowledgement and Agreement

I hereby consent to the collection of the information in this application and to its use for the purposes of assessing my suitability for employment with Peninsula Co-op and, if I am hired, for employment administration purposes.

I consent to an investigation of work and personal references as necessary to determine my suitability for employment.

I understand that upon being offered a position a criminal record and bonding check may be required and that I must maintain a clear criminal record throughout my employment with Peninsula Co-op. I further understand that certain positions may require a credit check.

I hereby authorize my current employer (if applicable) and all previous employers and organizations contacted by Peninsula Co-op to provide any relevant information regarding my current and/or previous employment and I release all persons, employers of any and all claims for providing such information.

I certify that the information given by me in this application is true and complete to the best of my knowledge. I understand and agree that if I am hired, if any information on this application is found to be false, such information may be cause for immediate dismissal.

 

Peninsula Co-op, #1-2132 Keating X Rd. Saanichton, BC V8M 2A6
Phone: Customer Service 250.652.1188, Administration 250.652.5752 or toll free 1.877.652.5752

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