Date when you are available for employment:

Family name:

First name:      

Middle name:

Present address:

Residence telephone:

Business telephone:

Are you in possession of a
valid driver's license?                                          yes        no

Have you received any demerit points
in the last 3 years?                                               yes        no

Are you legally eligible to work
in Canada?                                                             yes        no

Are you between 18 and
65 years of age?                                                    yes        no
Note:    If you are under 18 years of age, please provide evidence with your application that you are at least 16 years of age. 

Have you ever been convicted of a
criminal offence for which a pardon
has not been granted?                                        yes         no

Most recent education:
    University                  College                 High School

Name of educational institution:

Program name:

Primary area(s) of study:

Number of years completed, including this year:

My computer skills are:        Poor        Average        Excellent

Please check the following computer program(s)
which you are familiar with.
    MS-Word        MS-Excel        MS-Outlook        MS-Access

    Other (please list)

Do you have:
a)    proven research skills                                         yes        no
b)    proven report writing skills                               yes        no
c)    proven mechanical aptitude                               yes        no
d)    reliable transportation                                        yes        no
e)    security experience                                             yes        no

Keyboarding speed (w.p.m):       

Employment history:
1.    Name, address and telephone of current employer:
       

     Position held:
      

     Duties:
      

2.   Name, address and telephone of employer:
      

   Position held:
     

   Duties:
     

   Reason for leaving:

3.  Name, address and telephone of employer:
     

   Position held:
     

   Duties:
     

   Reason for leaving:
     

Specify special training, licenses, skills, trades and professional designations.
     

Languages spoken:            English        French        Other

Languages written:            English        French        Other

List three (3) persons who have agreed to provide a reference for you.
1.    Name, business address and telephone number:
      

2.    Name, business address and telephone number:
      

3.    Name, business address and telephone number:
      

Terms and Conditions of Employment

In consideration of this application, I hereby authorize Dr. Hudson's office or any agency acting on Dr. Hudson's behalf and without liability, to make whatever enquiries deemed necessary concerning all statements contained in this application.

I certify that the statement made by me in this application are true and complete to the best of my knowledge and believe and are made in good faith.

I understand that, if I am offered a position with Dr. Hudson I must provide Dr. Hudson with a recent Criminal Background Check prior to the start of my employment and that failure to do so will render the offer of employment null and void.

I understand that if any of these statements are untrue, this application may be rejected or any appointment to a position may be nullified.

We value diversity in the workplace, are committed to Employment Equity and will provide reasonable workplace accommodation to applicants with disabilities.

Although we appreciate the interest of all applicants, we advise that only applicants selected for further consideration will be contacted.

Thank you.