Township of South Frontenac

Summer Student Application Form

DATE: ______

Job Posting # ______

Job Title: ______

Name: ______

Address:______

______

E-mail:______

Phone #: ______

(Where we can reach you at between now and your start date):

Are you legally permitted to work in Canada? ______Yes ______No

Do you possess a valid G2 Drivers License? ______Yes ______No

Dates available for employment: ______

Dates within this period on which you will not be available for work (if any):______

Name of secondary/college/university/technical school: ______

Name of degree/diploma/certificate program: ______

Length of program: ______

Year just completed? ______

Date on which you are returning to full-time secondary or post secondary studies: ______

If you have been a South Frontenac summer student before, please give details: ______

______

If you have worked for any municipality other than South Frontenac as a summer student or other, please give details and number of hours worked, per year, with any other municipality: ______

______

Please list those experiences, skills or qualifications that you feel you possess. Include area where you have acquired those skills. (answer on a separate sheet of paper if necessary)

______

______

Are you attaching a resume: ______Yes ______No

References (give names of 3 persons, NOTrelatives, who would provide a reference for you – ie. teacher, school counsellor, former employer)

  1. Name:______

Occupation:______

Address:______

Phone number:______

e-mail:______

  1. Name:______

Occupation:______

Address:______

Phone number:______

e-mail:______

  1. Name:______

Occupation:______

Address:______

Phone number:______

e-mail:______

The following information will be required at time of hire:

  1. Social Insurance Number
  2. Date of Birth
  3. Bank Deposit Authorization
  4. Emergency contact

I hereby certify the information provided in this application to be accurate and complete.

I hereby authorize the Township of South Frontenac to investigate fully my work qualifications and references. I also hereby authorize my references as listed in Numbers 1, 2 and 3 above to give such information to the Township of South Frontenac.

I understand that personal information is collected here to be used by the Township of South Frontenac, for the purposes of summer student program administration and to meet government requirements, and by signing below, I consent to this collection, use, and necessary disclosure of my personal information for these purposes. It will not be retained or used for other purposes. It will be disclosed to third party service providers as contracted by the Township of South Frontenac to administer the program and as required by law.

______

Print Name of ApplicantSignature of Applicant

(to be signed at time of interview / hire)

Date: ______