Fillable Printable Sam's Club Application Form
Fillable Printable Sam's Club Application Form
Sam's Club Application Form
Application For Employment
Personal Information
Last Name: ......................................................................................... Middle Initial: .............................................. First Name: ....................................................................
Address: .............................................................................................. City: ...............................................................................................................................................................
Province: ............................................................................................. Postal Code: ................................................ Home Phone #: ............................................................
Alternate Telephone #: .................................................................. E-mail: ...........................................................................................................................................................
Have you worked at Wal-Mart/SAM’S CLUB before: o No o Yes If yes, which store: .................... If yes, note dates: ........................................................
Position
Position applying for: ................................................................................................................................................... o Seasonal /Temporary ...........................................
Are you interested in: o Full Time (Min. of 28 hrs per week) o Peak Time (Less than 28 hrs per week)
How did you learn about this opportunity? ........................................................................................................................................................................................................
Availability
Date available to start (dd/mm/yyyy): ...................................................................................................................................................................................................................
Indicate when you are available to be scheduled (specify a.m. or p.m.). Due to the nature of our business, the more available you are, the more
opportunities we can consider you for.
Saturday Sunday Monday Tuesday Wednesday Thursday Friday
From
To
Overnight yes/no
Education
Tell us the highest or equivalent level completed
Institution Type Completion Type of Certication/Diploma/Degree Received
High School Year Completed
o 1 o 2 o 3 o 4 o 5
Post Secondary
o 1 o 2 o 3 o 4 o 5
Reference Check Consent
Please provide at least 2 work-related references Wal-Mart may contact in the spaces below. List most recent employers, managers, supervisors only.
DO NOT list family and friends.
Supervisor’s Name: ............................................................. Position Title: .............................................. Name of Company: ....................................................
Address: ...............................................................................................................................................................................................................................................................
Can we contact them: ....................................................... Phone Number: ......................................... Your Position: ...............................................................
Date of Employment: ......................................................... Reason for Leaving: .................................. Duties: ..............................................................................
Supervisor’s Name: ............................................................. Position Title: .............................................. Name of Company: ....................................................
Address: ...............................................................................................................................................................................................................................................................
Can we contact them: ....................................................... Phone Number: ......................................... Your Position: ...............................................................
Date of Employment: ......................................................... Reason for Leaving: .................................. Duties: ..............................................................................
2
I certify that the information on this application is correct and I understand that any misrepresentation or omission of any information will result
in my disqualication from consideration for employment or if employed my dismissal for just cause. Wal-Mart Canada Corp may verify the
information set forth on this application and obtain additional background information relating to my background. I authorize all persons, schools,
companies, corporations, credit bureaus, law enforcement agencies and doctors to supply all information concerning my background.
On the rst day of employment I agree to provide Wal-Mart Canada Corp. proof of my age (as required for company benet plans and similar
administration), Social Insurance Number and appropriate credentials as may be required.
I understand that the rst 3 months of active service will be probationary during which time my employment may be terminated without notice
of termination of employment or pay in lieu thereof.
Candidate’s name (Please print): ..........................................................................................................................................................................................................................
Candidate Signature: .................................................................................................................................................. Date: ................................................................................
Date of Application: .............................................
WMP24CB Rev. 05/07
