This document contains an employment application form seeking personal information, availability, education history, and previous work experience from a potential job applicant. If hired, the applicant would be informed that their personal information would be used for payroll administration and benefits and may be shared with third parties. The applicant is asked to consent to pre-employment screening and agree that employment can be terminated at any time by either party.

1. Date: _____________________________
PERSONAL INFORMATION
Name ____________________________________________________________________________________________
Address __________________________________________________________________________________________
Phone Number ____________________________ Social Insurance No. ___________________________
Are you legally eligible to hold a job where you will have to handle liquor? ____________________________________
Are you legally entitled to work in Canada? _____________________________________________________________
If hired, how will you get to work? _____________________________________________________________________
Have you ever been or applied to be a Tucker’s employee before? ___________________________________________
(If yes) when & where? _____________________________________________________________________________
What do you do for fun? (Exclude activities, the name or character of which indicates race, creed, colour, religion,
national origin or politics).
__________________________________________________________________________________________________
How did you hear about us? Newspaper ad Employment Agency school referral
Flyer Signage at Location Other _______________________
EMPLOYMENT DATA
Which of our locations would you like to work in? _________________________________________________________
When can you start? ________________________ What wage do you expect? _______________________________
Do you have any obligations which would prevent you from working regularly, nights, weekends or overtime? ________
If yes, please explain _______________________________________________________________________________
I am seeking (check only one)
Part-time employment Full-time employment
If part-time, indicate # of hours/shifts desired ___________________________________________________________
When are you available?
Hours Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Available
From:
To:
EDUCATIONAL BACKGROUND:
Grammar School Trade, Business, Corresp. School
High School College, University
Details of apprenticeships, graduate, part-time studies, specific skills or training _________________________________
__________________________________________________________________________________________________

2. Please tell us where you have worked previously. List your last three employers, beginning with your current or most
recent job.
1. Name of Business:
Phone # & Location:
Name of Supervisor:
Why did you leave?:
When were you there?:
How many hours/week did you work?:
2. Name of Business:
Phone # & Location:
Name of Supervisor:
Why did you leave?:
When were you there?:
How many hours/week did you work?:
3. Name of Business:
Phone # & Location:
Name of Supervisor:
Why did you leave?:
When were you there?:
How many hours/week did you work?:
Please provide us with 3 references (do not list relatives)
NAME ADDRESS TITLE/OCCUPATION YEARS KNOWN
PLEASE READ
This company fully subscribes to the principles of human rights and ensures that all applicants and employees are
considered for hire, promotion, and job status, without regard to race, nationality, religion, colour, sex, age, marital
status, physical or mental handicap, ethnic or national origin, or political belief or family status.
Note: This application will be considered active for 90 days. If you have not been employed within this period and
are still interested in employment, you must submit a new application.
At Tucker’s Marketplace, we recognize and respect the importance of privacy. Personal information that we collect
will be used for the purposes of employment qualification and assessment and administration of the payroll and the
group benefits plan. We may disclose your personal information to third parties such as our payroll service provider
and our group benefits provider. We may also disclose your personal information where we are required by law to do
so. By providing your information to us you have consented to these uses and disclosures.

3. STATEMENT OF UNDERSTANDING
I certify that the information contained in this application is correct to the best of my knowledge and understand that
any misstatement or omission of information my result in dismissal in accordance with company policy. I authorize
the references listed above to give you any and all information concerning my previous employment and any pertinent
information they may have, personal or otherwise, and release all parties from all liability for any damage that may
result from furnishing same to you. In consideration of my employment, I agree to conform to the rules and
regulations of the company. I agree that my personal information can be used for the administration of the payroll
and group benefits plan and I further agree that such information can be provided to third parties which provide
payroll and benefit services. I agree that my personal information can be used to assess my performance as an
employee. My employment and compensation can be terminated with or without cause and with or without notice at
any time at the option of either the company or myself. I agree that, due to labour shortages, promotions or training,
I may be required to transfer from one restaurant to another. I consent to taking any pre-employment physical
examination as may be required in accordance with the company’s employment standards.
Applicant Acknowledgement  Please check if you are in agreement with this Statement.