First Name*

Last Name*

Gender*MaleFemaleOther

Email*

Date of Birth*

Phone Number*

Address*

Type of job*—Please choose an option—General LabourWelderFork Lift OperatorOffice AssistantManagerOthers

Do you own your own carYesNo

Expected Wages18192021222324252627282930

What shifts can you work*MorningAfternoonNight

Can you work on weekendsYesNo

Can you work overtimeYesNo

Days Available?MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Status*—Please choose an option—PRWORK PERMITCITIZENSHIPSTUDENT

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If you have any issuse regarding health and safety. Please explain below*