Job Application – Alberta Co-op

Name*

First Last

Pronouns*

Are you living in Portland, Oregon?

We get a lot of people that mistakenly apply from Alberta, Canada. So if you live in Portland, please check yes!

Yes
No

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

When is the best time to contact you?*

Position Applying for:*

When could you start?*

How did you hear about this job opening?*

List Availability*

Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday

Do you have any other outside commitments that may affect your availability?*

Have you ever been interviewed or employed at ACG?*

Yes
No

If yes, what department and what duration of time?

Are you legally eligible to be employed in this country?*

Yes
No

Will you be able to furnish proof of employment eligibility upon hiring?*

Yes
No

Are you at least 18 years of age?*

Yes
No

Heavy lifting is a part of our business. Are you able to lift up to 50lbs?*

Yes
No

Are you fluent in any Non-English languages?

Employment History

1. Current or Most Recent Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Start Date

End Date

Currently Employed Here?

Yes

May we contact this person?

Duties Worked

Reason for leaving

2. Past Employer

Note: Past Employer information fields may be left blank if this information is included on an attached resume.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Start Date

End Date

May we contact this person?

Reason for leaving

3. Past Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Start Date

End Date

May we contact this person?

Duties Worked

Reason for leaving

4. Past Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Start Date

End Date

May we contact this person?

Duties Worked

Reason for leaving

Volunteer or Other Applicable Experience

Other Applicable Experience

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code