Payroll Form
Payroll Agreement Form
Employee payroll Information
Section IV
Section II
TIS Application
Personal Information Consent
TRILLIUM TIS APPLICATION
FOR OFFICE USE ONLY
Available Start Date:
Interview by:
Instructions: Print clearly in black or blue ink. Answer all questions. Sign and date the form.
Please complete all questions.
Type of Position Applied for
Location Applied for:
Wage Expectation:
APPLICANT INFORMATION
Surname
Given Name
Middle
Initial
Street
Address
Apt./Suite #
City
Province
Postal Code
Main
Intersection
Home Phone
Email Address
Cellular or Pager
Who should we contact in case of an emergency? Name:
Relationship:
Home #
Cellular #
Are you eligible to work in Canada?
Yes
No
Are you at least 18 years of age?
Yes
No
How did you hear about Trillium Interim Staffing?
Have you ever worked or registered with other Staffing Agency?
Transportation:
Transit
Car
Other
Are you currently employed? No or Yes – What are your working hours?
Availability:
Day
Afternoon
Overnight
Full Time
Part Time
Temporary
Which following wok equipment do you own?
Safety Shoe
Safety Glass
Hard hat
Gloves
Hearing Protection
Are you able to lift 25 to 50 lbs?
Yes or No
Have you been convicted of a criminal offense that has not yet been pardoned?
Yes
No
If yes, please explain details:
What date are you available to start work?
EDUCATION:
Name and Address Of School
Degree/Diploma
Graduation Date
Skills and Qualifications: Licenses, Skills, Training, Awards
EMPLOYMENT HISTORY:
Employer:
From:
To:
Address:
Supervisor:
Phone:
Email:
Position Title:
Job Descriptions:
Reason for Leaving:
Employer:
From:
To:
Address:
Supervisor:
Phone:
Email:
Position Title:
Job Descriptions:
Reason for Leaving:
May we contact these employers for references?
Yes
No
Recognizing the importance of trust in an employee relationship and that Trillium will be relying on the information which I have provided to the company, by my signature on the application form, I:
Authorize the verification of the above information and any other necessary inquiries which may be needed to determine my suitability for employment.
Affirm that the above information is true to the best of my knowledge.
Acknowledge that misrepresenting or supplying false/inaccurate information may result in immediate rejection of my application or result in dismissal for cause.
Applicant’s Signature
Date:
Please check each experience that applies to you
Industrial
Plastics
Skilled Trades
Maintenance
Assembly
Blow Mold
Tool & Die
Janitorial
Grinding
Injection Molding
Carpentry
Building Maintenance
Rework
Silk Screen
Electrical
Landscaping
Inspection
Plumbing
Machine Maintenance
Painting
Equipment
Journeyman
Custodian
Constructions
Jackhammer
Housekeeper
Lumber Handling
Saw
Mechanics
Moving Furniture
Bobcat
Heavy
Forklift
Caterpillar
Automotive
Raymond Reach
Warehouse
Crane
Apprentice
Reverse Raymond Reach
Shipping/Receiving
Overhead Crane
Cherry Picker
Palletizing
Food Service
Pump Truck
Loading/Unloading
Welding
Hospitality
Pallet Truck
Shipping Clerk
Aluminum/Stainless
Banquets
Narrow Aisle
Order Entry
Arc
Bartending
Propane
Inventory
Sub-Arc
Cooking
Diesel
Stocking
Mig/Tig
Dishwashing
Gasoline
Material Handling
Class 1
Food Preparation
Walkie
Order Picking/Packing
B Pressure
Laundry
Serving Tables
Technical
Printing & Bindery
Machine Operator
Busing
Schematics
Printing Press
Machinist
Smart Serve Training
Soldering
Bailer
Extrusion Moulder
PC Board
Collator
Intrusion Moulder
Other Skills
Colour Codes
Stitcher/Trimmer
Lathe
Cashier
Electrical Assembly
Folder
Pipe Fitter
Dispatcher
Mechanical Assembly
Shrink wrap/mail
Punch Press
Mailroom
Micrometers
Brake Press
Delivery/Courier
Drill Press
Drop Press
Grinder
Packer
Industrial Sewing Machine Operator
Interview Comments
Email Address:
(To whom the pdf wil be mailed)
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