| Davison Orchards Country Village

First Name *

Last Name *

Street Address *

City, Province *

Postal Code *

Phone # *

Cell Phone #

Email *

Do you have a Social Insurance Number that allows you to work in Canada? *

Yes

No

Do you know anyone working at Davison Orchards now? *

Yes

No

If Yes, who?

Desired Placement (Check ONLY 3) *

First Day Available in 2013 (MM/DD) *

Last Day Available in 2013 (MM/DD) *

Which days are you available? (select all that apply) *

Please specify your highest level of education completed.

What additional training/courses have you completed?

List personal interests or activities.

Current/Most Recent Employer

May we contact this company?

Yes

No

Start Date (current employer)

End Date (current employer)

Supervisor's Name

Current Employer Phone Number

Position/Duties

Reason for Leaving

Previous employer

Can we contact this company?

Yes

No

Start Date (previous employer)

End Date (previous employer)

Supervisor's Name

Previous Employer Phone Number

Position/Duties

Reason for Leaving

As a guest at Davison Orchards, what is important to you? *

Why would you like to work at Davison Orchards? *

List a reference not given previously. Please provide their name, occupation, your relationship to them and any other information you think relevant (do not list relatives). *

Reference Phone Number *

Please list any additional references here and provide their name, your relationship to them, and a phone number to contact them.

Attach Resume / Cover Letter: *

I acknowledge that the statements and information given on this application are true and accurate as of this date. *

Yes

I authorize Davison Orchards to thoroughly investigate my background, references, employment records and other matters related to my suitability for employment. QUESTIONS MARKED WITH AN ASTERISK (*) REQUIRE ANSWERS. PLEASE LOOK CAREFULLY. *

Yes

Date *