Application For Employment

Personal Information

Last Name: ......NAZARI................................................................................... Middle Initial: ........

...................................... First Name: ....SOMAYA................................................................

Address: ...2775 DONMILLS RD...................................................................................... City: .toronto..............

...............................................................................................................................

.................

Province: ..ontario........................................................................................... Postal Code: m2j3b5........

........................................ Home Phone #: ............................................................

Alternate Telephone #: .................................................................. E-mail: ..somnaz@hotmail.com.........................

...............................................................................................................................

.

Have you worked at Wal-Mart before:

No  ---------

Ye s

If yes, which store: ......................... If yes, note dates: ........................................................

Is there someone you would like to refer for a position at Wal-Mart?

Name: ................................................................................................... Contact Information:

.............................................................................................................................

.

Position

Position applying for: ....cashier...................................................................................................

............................................

Seasonal /Temporary ...temporary........................................

Are you interested in:

Full Time (Min. of 28 hrs per week)

Peak Time (Less than 28 hrs per week)

How did you learn about this opportunity? .....................................................................................

...................................................................................................................

Availability

Date available to start

(dd/mm/

yyyy)

: .......01/05/215.....................................................................................................................

.......................................................................................

Indicate when you are available to be scheduled (specify a.m. or p.m.). Due to the nature of our business, the more available y

ou are, the more

opportunities we can consider you for.

Saturday Sunday Monday Tuesday Wednesday Thursday Friday

From   monady

To     friday

Overnight yes/no

Education

Tell us the highest or equivalent level completed     4,5

Institution Type Completion Type of Certifi

cation/Diploma/Degree Received

High School Year Completed

1

2

3

4

5

Post Secondary

1

2

3

4

5

Employment History

Current/Last Position Title: ................................................................................................

............................ Company Name: ..........................................................

Company Address: ............................................................................................................

...............................................................................................................................

Responsibilities: ...........................................................................................................

...............................................................................................................................

......

Date of Employment: .........................................................................................................

.............................. Reason for leaving: .....................................................

Supervisors Name: ...........................................................................................................

................................. Position Title: ................................................................

May we contact them?

Ye s

No

Supervisors Contact Number: ............................................................................................

........................................

Current/Last Position Title: ................................................................................................

............................ Company Name: ..........................................................

Company Address: ............................................................................................................

...............................................................................................................................

Responsibilities: ...........................................................................................................

...............................................................................................................................

......

Date of Employment: .........................................................................................................

.............................. Reason for leaving: .....................................................

Supervisors Name: ...........................................................................................................

................................. Position Title: ................................................................

May we contact them?

Ye s

No

Supervisors Contact Number: ............................................................................................

........................................

I certify that the information on this application is correc

t and I understand that any misrepresentation or omission of any in

formation will result in my disqualifi

cation from consideration for employment

or if employed my dismissal for just cause. Wal-Mart Canada Corp may verify the information set forth on this application and o

btain additional background information relating to my background.

I authorize all persons, schools, companies, corporations, credit bureaus and law enforcement agencies to supply all informati

on concerning my background.

On the fi

rst day of employment I agree to provide Wal-Mart Canada Corp. proof of my age (as required for company benefi

t plans and similar administration), Social Insurance Number and appropriate

credentials as may be required.

I understand that the fi

rst 3 months of active service will be probationary during which time my employment may be terminated without notice of termin

ation of employment or pay in lieu thereof.

Candidate’s name (Please print):

..............................................................................................................................

............................................................................................

Candidate Signature:

......somaya nazari.......................................................................................................................

.....................

Date:

.....25/05/2015...........................................................................

Feel free to attach a resume to this application form

Date of Application: ..25/05/2015...........................................

WMP24CB Rev. 08/09

†

†

†

†

†

†

†

†

†

†

†

†

†

†

†

†

†

†

†