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Hitachi Canadian Industries Ltd.

Hitachi

Personal Information

First name:
Last name:
Telephone number: ( ) -
Alternate telephone number: ( ) -
Email address:
Current address:  
Street Address:
City:
Province or State:
Country:
Postal or Zip Code:

Position of interest:
Full-Time   Part-Time
Rate of pay expected:
Hourly   Monthly   Yearly
Date available for work: DD MM YY
Are you a former HCI employee? Yes No
Have you previously applied for a position with our company? Yes No
How did you hear about this position?

Record of Education

High School
Name of School:
 Highest grade completed:

Did you graduate?
Yes
No
Post-Secondary:

Name of School:

Area of study:

Apprenticeship level:

Did you graduate? Yes No

If yes, with a:
Degree Diploma Certificate

Date completed: MM YY

Length of program:
Months
Years

Certificate/Diploma/Degree received:

Employment History
List below, beginning with your most recent, all present and past employment:

Name of business:

Address of Employer:

City:

Province or State:

Country:

Phone Number:

( ) -

Employed from: MM YY to MM YY Present
Reason for leaving:
Starting salary:

Hourly
Monthly
Yearly 		Last salary:

Hourly
Monthly
Yearly
Describe tasks:

Name of supervisor:

 May we contact this employer?
Yes No

Name of business:

Address of Employer:

City:

Province or State:

Country:

Phone Number:

( ) -

Employed from: MM YY to MM YY
Reason for leaving:
Starting salary:

Hourly
Monthly
Yearly 		Last salary:

Hourly
Monthly
Yearly
Describe tasks:

Name of supervisor:

 May we contact this employer?
Yes No

Name of business:

Address of Employer:

City:

Province or State:

Country:

Phone Number:

( ) -

Employed from: MM YY to MM YY
Reason for leaving:
Starting salary:

Hourly
Monthly
Yearly 		Last salary:

Hourly
Monthly
Yearly
Describe tasks:

Name of supervisor:

 May we contact this employer?
Yes No

Additional Training

Please indicate if you have completed the following courses:

Course: Course completed: Certificate received? Completion date:
WHMIS: Yes No Yes No MM YY
ISO: Yes No Yes No MM YY
Forklift: Yes No Yes No MM YY
Overhead crane: Yes No Yes No MM YY

Other:

 Yes No Yes No MM YY

Additional Information

Some jobs at HCI may require travelling. Are you eligible to travel outside of Canada?
Yes No

Some jobs at HCI may require the use of a respirator.  Are you able to safely wear a respirator?
Yes No

Production positions, at HCI, require our staff be able to consistently lift, carry and push loads of various weights.   Standing, bending, and kneeling are also required movements.  Are you able to perform all of these functions?
Yes No

If you answered “No” to the above, please state which function you cannot perform and what accommodations could be made for you to adequately complete the work.

_____________________________________________________________________

Please note that by submitting this application you agree to the following:

I declare that the information I have provided in the application procedure is true, and I acknowledge that my employment may be terminated if information I provide is found to be untrue.

Thank you for your interest in a career with Hitachi Industries Ltd.  Only those candidates selected for an interview will be contacted.