Address: 1004 Middlegate Road, Suite 1000 Mississauga, Ontario L4Y 1M4 Canada.

Tel: +1 (757)285-8983, +1 (905) 896-8900, +1 (780) 444-3042

Fax: +1 905.896.36272

APPLICATION FOR EMPLOYMENT

*If you have difficulty in completing this application, please call for assistance*
PERSONAL DATA
PLEASE PRINT LEGIBLY. COMPLETE ALL APPLICABLE ITEMS. USE INK ONLY. DATE: __________________________________________

NAME: _____________________________________________________________________________ ___________ AGE(dd/mm/yy)_________________________________

ADDRESS: ___________________________________________________________________________________________________________________________________
(STREET) (CITY) (STATE)

PERMANENT ADDRESS: _______________________________________________________________________________________________________________________

(STREET) (CITY) (STATE)

PHONE: _____________________________ ALTERNATIVE PHONE: ____________________________ INT’L PASSPORT NUMBER: __________________________

Are you a Canadian Citizen or do you have the legal right to work in CA? Yes No Are you at least 18 years of age: Yes No
(you must be at least 18 to be eligible for employment here)
If hired, can you furnish proof that you are eligible to work in Canada? Yes No

Do you have a current driver’s license? Yes No If yes, list state and license number: _________________________________________

Have you ever been convicted or plead guilty to (or no contest to) a crime of any kind? Yes No If yes, please explain: ___________________________

_________________________________________________________________________________________________________________
JOB PREFERENCE
Type of employment desired: Full Time Part Time Seasonal/Temporary, Dates _______________________________________

Are you applying for a specific position? Yes No If so, which one? __________________________________________________________________

Do you have any limitations which would prevent you from performing the essential functions of the job for which you are applying? Yes No

Do you understand that you are subject to a post-offer physical screening/evaluation? Yes No

Please circle the days you are able to work: S M T W T F S

Are you willing to work any hours? Yes No If no, specify hours desired: _______________ Are you willing to work weekends/holidays? Yes No

When would you be available to work? ____________________________________Have you ever worked for Ellisdon Corporation? Yes No

If yes, please state location ___________________________________________________________________________________________________________

How did you hear about our job opening? __________________ Were you recommended by a friend? Yes No Name: ___________________
EMPLOYMENT HISTORY  JOB POSITION APPLIED FOR:

STARTING WITH PRESENT OR MOST RECENT EMPLOYER LIST PREVIOUS EMPLOYMENT FOR THE LAST THREE YEARS.
DO NOT OMIT ANY EMPLOYMENT. ATTACH ADDITIONAL PAGES IF NECESSARY.

EMPLOYER ________________________________________________________ Position Held ________________________________________________

Address ____________________________________________________________ Supervisor __________________________________________________
City/State/Zip _______________________________________________________ Rate of Pay __________________________________________________
Telephone ______________________________ Date__________ to __________ Reason for Leaving (if discharged, please explain in detail) _____________
______________________________________________________________________________________________________________________________
_____________________________________________________________________________Expected Salary Package_______________________________

EMPLOYER ________________________________________________________ Position Held ________________________________________________

Address ____________________________________________________________ Supervisor __________________________________________________
City/State/Zip _______________________________________________________ Rate of Pay __________________________________________________
Telephone ______________________________ Date __________ to __________ Reason for Leaving (if discharged, please explain in detail) _____________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________

EMPLOYER ________________________________________________________ Position Held ________________________________________________

Address ____________________________________________________________ Supervisor __________________________________________________
City/State/Zip _______________________________________________________ Rate of Pay __________________________________________________
Telephone ______________________________ Date__________ to __________ Reason for Leaving (if discharged, please explain in detail) _____________
______________________________________________________________________________________________________________________________

May we contact all employers listed above: Yes No If No, explain: ___________________________________________________________
Have you ever been discharged or asked to resign from a job? Yes No

EDUCATIONAL QUALIFICATIONS

University/
Institute/ Duration

Examination/ College/ (from Subjects studied/ Marks/

Board
Degree School mm/yy to Specialization Rank
name name mm/yy)

Starting with present qualification (Attach additional pages if necessary):_____________________________________________________________________

______________________________________________________________________________________________________________________________

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for immediate
dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the day of payment of my wages and salary, be
terminated at any time without any previous notice. Any job offer is contingent upon results of drug testing within specified time period. I understand that my
eligibility to legally work in the Canada must be verified at the time of employment.

Sign: ____________________________________________________________________________________ Date: _________________________________