General Information
Which location are you applying for? (select all that apply):	Royal OakSaltspring EsquimaltLake Cowichan Cobble HillNanaimo
Last Name:	*
First Name:	*
Initial:
Present Address:
Address:	*
City:	*
Province:	Select Province Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Is. Quebec Saskatchewan Yukon Territory  *
Postal Code:	*
Home Phone Number:	*
Cell Phone Number:
Email Address:	*
Confirm Email Address:	*
Are you eligible to be bonded?	YesNo *
Is your age at least 15 years?	YesNo *
Are you legally entitled to work in Canada?	YesNo *
Areas of Interest:	Front EndFloral ProduceMeat DeliBulk BakeryOffice GroceryWarehouseman Postal
Salary Desired:
Part Time:
Full Time:
Have you every worked for Country Grocer?	YesNo
List any friends or relatives working for Country Grocer:
Is your ability to perform the duties of the position you are applying for likely to be affected by a previous illness or disability?	YesNo
Education
High School:
Last Grade Completed:	Select Year 9 10 11 12
Did you Graduate?	YesNo
Degree/Diploma Received:
College:
Last Year Completed:	Select Year 1 2 3 4
Did you Graduate?	YesNo
Degree/Diploma Received:
Employment History
Name of Current or Previous Employer:	*
Address:	*
City:	*
Province:	*
Postal Code:
Country:
Salary or Hourly Wage:	*
Postion Title:	*
From:	Select Month January February March April May June July August September October November December Select Year 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980  *
To:	Select Month January February March April May June July August September October November December Select Year 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980  *
Reason for Leaving:	*
Supervisor's Name:
Supervisor's Phone Number:
Attach your cover letter:
Attach your resume:
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Acknowledgement and Agreement

I hereby authorize Country Grocer to thoroughly investigate my background, references, employment record and other matters related to my suitability for employment. I authorize my current employer and all previous employers and organizations contacted by Country Grocer to provide any relevant information regarding my current and/or previous employment and I release all such persons and/or employers of any and all claims for providing such information. I acknowledge that my employment with Country Grocer may be with any one of Country Grocer’s affiliated companies and agree that I may be transferred between stores from time to time without a change in my terms of employment. I will follow all Country Grocer’s policies and that failure to do so may result in administrative or disciplinary action and/or my employment being terminated. I understand that I may be required to sign a confidentiality agreement should I become an employee of Country Grocer. I understand that upon being offered a position a bonding check may be conducted. I certify that the information given by me in this application is true and complete to the best of my knowledge. I understand that if I am employed, if any such statement on this application is at any time found to be false, such information may be cause for immediate dismissal.

 I acknowledge and agree to these terms and conditions. 

To the Applicant:

Country Grocer is an equal opportunity employer dedicated to a policy of non-discrimination in employment on any basis including race, ancestry, place of origin, political belief, religion, marital status, physical or mental disability, gender, age, or any other basis prohibited by federal or provincial law. We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. Our goal is to employ people who are interested in working in a team environment, who want to keep learning and growing as individuals, and who truly enjoy being around lots of other people.