Metro Ontario Inc.

Please print clearly in ink – Answer all questions completely

Type of Employment:Location:Store Distribution Centre Pharmacy

Position Applied for:

Personal Data

Last Name

Address

Province

Postal CodeHome Telephone #

Alternate Telephone #

If yes please indicate relationship? and work location:

Are you under the age of 18? : Yes No

If yes, please state your age

Are you currently enrolled in school? Yes No

If lifting is a bona fide occupational requirement are you

capable of heavy repetitive lifting? Yes No

Educational Background

Employment Application

Community College

Name of Course

Length of Course

Diploma Received? Yes No

Specify

Revised October 2008

For employment references may we approach your present employer? Yes No Your previous employer? Yes No

List references if different than above on a separate sheet. Have you attached an additional sheet? Yes No

Have you ever been convicted of a criminal offence, other than one for which a pardon has been granted under the

Criminal Records Act (Canada)? Yes No If yes, please provide particulars:

I understand my employment may be contingent upon completion of a Criminal Record Check and its review. Yes No

If the location you are applying to is open seven days per week, Sunday through Saturday please indicate your preferred hours specifying

a.m. or p.m. We encourage you to be as flexible as possible as availability will be considered in any hiring decision. It is understood that you

To

Please confirm that you are willing and available to work Sunday Yes No Saturday Yes No

I hereby authorize investigation of all statements obtained in this application including the obtaining of a Criminal Record Check to Metro

Ontario Inc. I affirm said information is true and complete to my knowledge and I understandthat any misrepresentation, falsification or

willful omission herein shall be sufficient reason for dismissal from, or refusal of employment.

Applicant Signature Date: / /