E-mail:       jnuchter@mpccircuits.com

Phone:         (613) 739-5060
Fax:             (613) 739-1041                                   

On-line Application

Job(s) applied for

  Rate of pay expected  $ per

  Rate of pay expected  $ per

How did you learn of this opening?

Do you want to work           Full Time  or   Part Time 

Specify days and hours if Part Time

Have you worked for us before?      No    Yes
If yes when?

If hired, on what day will you be available to start work?

Are there any other experiences, skills or qualifications, which you feel would especially 
fit you for work with us?

If hired, do you have reliable means of transportation to get to work?    Yes     No

Personal Information

Name

(First)

(Middle I.)

(Last)

Present Address

Street:
City:
Province:
Postal Code:
Telephone No.
Education Background
High School
College
University
Years Completed
Diploma / Degree
Describe course of study (Do not give name of school).
Describe any specialized training, apprenticeship skills and extra curricular activities.
Describe any honours you have received.
Prior Work History
1)
Period Worked From
To
Name of Employer
Supervisor's Name
Supervisor's Title
Company Address
Street:
City:
Province:
Postal Code:
Telephone No.
Reason for Leaving
Describe in detail the work you did.
2)
Period Worked From
To
Name of Employer
Supervisor's Name
Supervisor's Title
Company Address
Street:
City:
Province:
Postal Code:
Telephone No.
Reason for Leaving
Describe in detail the work you did.
3)
Period Worked From
To
Name of Employer
Supervisor's Name
Supervisor's Title
Company Address
Street:
City:
Province:
Postal Code:
Telephone No.
Reason for Leaving
Describe in detail the work you did.
May we contact the employers above?   Yes   No
Personal References Give the names of at least 3 persons who can supply information pertinent to your job performance (excluding former employers or relatives).
Name	Occupation	Address	Phone Number
Name	Occupation	Address	Phone Number
Name	Occupation	Address	Phone Number
Name	Occupation	Address	Phone Number
Name	Occupation	Address	Phone Number
Occasionally the form of an application blank makes it difficult for an individual to adequately summarize their complete background. To assist us in finding the proper position for you in our company, use the space below to summarize any additional information necessary to describe your full qualifications.
Thank you for completing this application form and for your interest in employment with us. We would like to assure you that your opportunity for employment with this company would be based only your merit and on no other consideration.
PLEASE READ CAREFULLY APPLICANT'S CERTIFICATION AND AGREEMENT.
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal.