WORKFORCE Application

Employment Application

(This is for Temp work at one of the following branches)
Which WORKFORCE Branch are you wanting to work for?*

VANCOUVERSURREYCALGARY NORTHCALGARY SOUTHEDMONTON
Personal Information:
Date

MonthDayYear
Date
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Social Insurance Number
Birth Date*

MonthDayYear
What is your sex?*

MaleFemale
Do you have a vehicle?*

YesNo
Have you ever worked for a temporary employment agency before?*

YesNo
Skills/Qualifications:

Please indicated any experience you have in any of the following areas:*

	0-1 Years	1-3 Years	3+ Years
Construction Labour
Form Stripping
Carpentry
Concrete Finishing
Drywall
Flagging
Heavy Equipment Operator
Forklift
First Aid Attendant
Safety Office CSO
Warehousing
Painting
Roofing
Landscaping
Moving

List any other Skills or Experience you have:
List any relevant skills
IN THE SPACE PROVIDED BELOW, PLEASE LIST: Any tickets, qualifications or completed safety courses you have (i.e. WHMIS, St. John’s Ambulance), any tools or equipment you own, or any other helpful information.
List any relevant certifications or qualifications
References:
Reference 1
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone
Email
Cover Letter & Resume (Optional):
Cover Letter

Upload a File

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Resume

Upload a File

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Medical History:

This medical information is requested for the purposes of assisting us in placing you within a work position suitable to your capacity andtherefore minimizing the risk of serious injury to yourself, your fellow workers and/or the public.*

	YES	NO	Comments
Have you ever had a head injury?
Do you have epilepsy?
Do you have dizzy or fainting spells?
Do you have diabetes?
Have you ever had a hearing problem?
Have you had a previous eye injury?
Have you had any previous fractures?
Have you had a previous injury to any major joints? i.e. ankle, knee, hip, elbow, shoulder?
Do you have a heart condition?
Do you have high blood pressure?
Have you ever had any back problems?
Do you have any allergies? Is yes please specify
Do you have any respiratory problems? If yes please specify
Do you have a hernia? If Yes, please specify
Are you taking medications at present time? If Yes, please specify
Have you seen a physician for any illness, injury or surgery in the past year? If Yes please specify
Are you medically cleared and fit to work with no restrictions or disabilities from any previous occupational injury, illness or medical condition?
Is there any other pertinent medical illness or injury related information you feel we should be aware of? If Yes, please specify
Are you bondable?
Have you ever been charged with an indictable offence under the Criminal Code of Canada?

On Call and Dispatch Procedure:
ON CALL PROCEDURE
If I am designated an “On-Call” employee by Workforce Staffing Solutions Ltd., my name will be placed in the skilled worker file(s) as considered appropriate by the management of Workforce Staffing Solutions Ltd. If I am unavailable for work, or Workforce Staffing Solutions Ltd. is unable to contact me on three (3) consecutive occasions, I understand that my name may be removed from the on-call list. I understand that all work is strictly on a casual basis and that I do not commence work until I have attended and started working at the location to which I have been dispatched. I also understand that none of the above constitutes a guarantee of work

DISPATCH PROCEDURE
I understand that if I wish to be eligible for dispatch work for a particular day, I will present myself at Workforce Staffing Solutions Ltd. office and indicate my availability for dispatch by placing my name on the sign-in sheet. I understand that work may be assigned from names on the sign-in sheet and that if I do not respond when my name is called Workforce Staffing Solutions Ltd. may assume that I am no longer available for dispatch and may
dispatch someone else. I understand that all work is on a casual basis and that I do not commence work until I have attended and started working at the location to which I have been dispatched. I understand that none of the above constitutes a guarantee of work.

I the undersigned, duly declare the above information to be accurate and correct to the best of my knowledge. I understand that any omissions or misrepresentations may result in reclassification or dismissal upon review by my employer. I further authorize my employer to obtain a medical evaluation by a physician if required.
Signature*

Clear

Injury Reporting Agreement:
Injury Reporting Agreement

By signing this document, I acknowledge and agree to the following:

1.      That the supervisor on my assignment is not my employer (as defined by the Worker’s Compensation Act and Occupational Health and Safety legislation)

2.      It is as much my responsibility as it is my employers to ensure a workplace is safe. I will act in a way that does not put other employees in danger and will use all my safety equipment that is required

3.      I will report all injuries on the date of injury/illness to Workforce Staffing Solutions

4.      I will attend Workforce’s office to report all injuries, or if that is not possible, I will call and speak with Workforce Staffing Solutions personnel

5.      In the event I am injured, I am aware of the availability of modified employment duties and agree to discuss this with my physician directly

6.      Following an injury, I agree to contact my local Workforce Staffing Solutions branch frequently to provide an update of my status

7.      I understand that I may be requested to take a post-accident Alcohol & Drug test

8.      That I will cooperate with all efforts by Workforce Staffing Solutions to help me recover from an injury

Policies and Procedures

Workforce Staffing Solutions has developed a general Policies and Procedures Manual to protect the health and well-being of our employees, our clients and our company as a whole. Workforce firmly believe that these practices promote a desirable work environment and help ensure workplace wellness.

The Policies and Procedures manual covers the following topics:

- Company Rules

- Disciplinary Policy

- Personal Protective Equipment

- Safety Responsibility

- Emergency Preparedness

- Accident/Incident Reporting

- Safe Work Practices/Procedures

The complete Policies and Procedures manual is available upon request.

I am aware that it is entirely my responsibility to ensure that I have obtained and understand the contents of the manual completely and fully. If there is any part(s) of the aforementioned that I do not fully comprehend or which I require clarification, I hereby acknowledge my responsibility to seek said clarification from Workforce Staffing Solutions. I am also fully and completely aware that any breach I might cause, whether intentionally or unintentionally, of the policies and procedures outlined in the manual my result in disciplinary action by Workforce against myself, up to and including termination of employment.

By signing below I understand and I am bound by the Injury Reporting Agreement and the Policies and Procedures listed above.
Signature*

Clear

Worker Safety Orientation

But signing below you agree that you are familiar with all of the following Health and Safety topics and understand the safe work procedures can be practiced for most hazards encountered in the workplace.

 WHMIS: The three elements of information delivery: Labeling/SDS/ Worker Education
 PERSONAL PROTECTIVE EQUIPMENT (P.P.E): – Head/Eyes/Hands/Respiratory
(hazard/protection/availability)
CRITICAL TASKS: How to avoid soft tissue injury by following safe work practices
 HEARING CONSERVATION: Testing/Monitoring Protection
 FALL PROTECTION: Rules/Hazard areas/Responsibility
 FIRST AID: Reporting Injuries/ Availability/ Reporting to Office
 LIGHT DUTY PROGRAM- RETURN TO WORK COORDINATOR
 REFUSAL OF UNSAFE WORK
 VIOLENCE IN THE WORKPLACE
 DISCIPLINARY POLICY: 1
st/2nd/ 3rd offence
 COMPANY SAFETY POLICY: Availability/ Understanding
 HAZARD ASSESSMENT ORIENTATIONS/SITE ASSESSMENTS
 COMPANY RULES: Availability/ Understanding
 WORKER COMPENSATION ACT: Availability
 OCCUPATIONAL HEALTH & SAFETY REGULATIONS: Availability
 REPORTING OF INCIDENTS/NEAR MISSES AT ALL TIMES
 PURCHASE OF P.P.E ONLY NO RENTALS ALLOWED: STEEL TOES $ 50.00, VEST
& HARD HAT $ 15.00 EACH, GLOVES $ 4.00 & SAFETY GLASSES $ 3.00
 SURCHARGES ON CASH ADVANCES: $1.00 FOR EVERY $ 5.00 TAKEN,
 EMPLOYEE RIDES: Employees will be charged a ride fee of $2.50 each way driven by
Workforce Staff and or another employee to sites.
 JOBSITE ORIENTATION/ TRAINING
 FIRE RESPONSE PLAN – DISPATCH OFFICE/JOBSITES
 JOINT HEALTH & SAFETY COMMITTEE (JHSC) STAFF MEMBERS ARE:
Annaghia Meredith (RTW Coordinator) and Kayla Kendy
Signature*

Clear

Employment Application

Personal Information:

Skills/Qualifications:

References:

Cover Letter & Resume (Optional):

Medical History:

On Call and Dispatch Procedure:

Injury Reporting Agreement:

Worker Safety Orientation Quiz