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General Application – Quebec

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General Application – Quebec

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Personal Information

First Name

Last Name

Date of Birth (DD/MM/YYYY)

SIN

Address

Appt#

City

Province

Postal Code

Cellphone number

Home Phone

Are you legally entitled to work in Canada?

Yes No

Do you require a work permit to work in Canada?

Yes No

If yes, expiry date

Have you been the subject of a conviction for a criminal offense for which a pardon has not been granted?

Yes No

If yes, please give the nature of the offense:

Education and Training

Level of education

Name of institution

Course Name

Year completed

Level of education

Name of institution

Course Name

Year completed

Emergency contact

Full Name

Cell Number

Home Number

Relationship

Desired positions

Desired position(s):

Desired status:

Permanent Temporary Full-Time Part-Time

Available days:

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Means of transportation:

Public Transit Vehicle Other

If other, please specify:

Which following work equipment do you own :

Safety Shoes Safety Glasses Hard Hat Safety Gloves Hearing protection

Minimum hourly rate or salary:

Available Start Date:

Desired Work Locations

Employment History

Employment #1

Employer (Company name)

Years (From - To)

Address

Supervisor's name

Position Title

Phone

Employment #2

Employer (company name)

Years (From - To)

Address

Supervisor's name

Position Title

Phone

Physical Demands / analysis

Physical demands / requirements

Standing

Yes No

Sitting

Yes No

Walking

Yes No

Lifting - Moderate I - 11 to 26lbs (5 to 11kg)

Yes No

Lifting - Moderate II - 26 to 40lbs (11 to 18kg)

Yes No

Lifting - Heavy I - 40 to 65lbs (18 to 30kg)

Yes No

Lifting - Heavy II - Greater than 65lbs (30kg)

Yes No

Carrying - 1 to 20lbs (1 to 9kg)

Yes No

Carrying - 21 to 40lbs (10 to 18kg)

Yes No

Pushing - 1 to 40lbs (1 to 9kg)

Yes No

Pushing - 21 to 40lbs (10 to 18kg)

Yes No

Pulling - 1 to 40lbs (1 to 9kg)

Yes No

Pulling - 21 to 40lbs (10 to 18kg)

Yes No

Climbing Ladders / Catwalks

Yes No

Kneeling

Yes No

Repeat Bending

Yes No

Crouching

Yes No

Reaching - Forward

Yes No

Reaching - Overhead

Yes No

Repetitive finger movement

Yes No

Repetitive hand movement

Yes No

Repetitive twisting or pressure of wrist

Yes No

Working conditions

Cold Environments

Yes No

Hot to warm Environments

Yes No

Dusty Environments

Yes No

Dry Atmospheric Conditions

Yes No

Working Alone

Yes No

Other work-related limitations:

Check to confirm

Check to confirm you answered the above to your best knowledge

General Authorization

General Authorisation

By checking the box, you accept the below:

By completing and submitting this application, I authorize Fuze HR Solution Inc or its agent to investigate my background, character, general reputation and prior employment by contacting my prior employers, references or any individuals Fuze HR considers necessary, (understanding that I have the right to request in writing disclosure of certain information obtained by Fuze HR in the course of its investigation of my background and experience).

I authorize Fuze HR, my prior employers, references and any other individual contacted by Fuze HR to release any and all information they may have regarding me and to absolve those parties who provide information requested from any and all liability related to their doing so. I acknowledge that any employment offered to me is at will and may be terminated by Fuze HR at any time, with cause or according to the mandate.

I certify by my signature that this application and all information in it are true and complete to the best of my knowledge and agree that providing false, misleading or incomplete statements in this application or in connection with Fuze HR’s evaluation of me as a candidate for employment is grounds for immediate termination of my employment, regardless of when such information is discovered.

Fuze HR respects your rights to privacy and takes its responsibilities regarding the collection, use and disclosure of your personal information seriously. Fuze HR is subject to the Freedom of Information and Protection of Privacy Act and has made appropriate security arrangements to protect the personal information in its care against such risks as unauthorized access, collection, use, disclosure or disposal.

Fuze HR is collecting your personal information in this application in order to assess your qualifications and suitability as a potential employee of Fuze HR. Fuze HR will not disclose this information to third parties unless it is legally required to do so.

Should you accept employment with Fuze HR, your personal information will be retained throughout your employment and for at least seven years following the termination of your employment for any reason. If you do not immediately obtain employment with Fuze HR, your personal information may be kept in our online database for a maximum of 6 months. You may choose to remove this information at any time.

Background Checks and Other Payroll Deductions

Accept the terms

By checking the box, you hereby authorize Fuze HR Solutions Inc to make deduction from my wages for the above selected payroll deductions and terms below:

Some of our clients require background verification and other equipment needed to preform your duties at their workplace. Fuze HR makes no profit on these transactions and is only acting as an administrator for our clients. We have negotiated the lowest price possible available to us at this time.

If we do need to performe a background check before sending you to an assignment, fees may apply. The different background checks: Criminal Background Check ($25.00), Credit Check ($15.00), or both ($35.00). The fee(s) will be deducted from your paycheck.

For some assignments, material such as a swipe card may be required. Swipe Card deductions will be reimbursed to you when the materials are returned to Fuze HR or the client upon completion of your assignment. There is no charge for this unless the material is not retuned to Fuze HR upon completion of your assignment.

In signing this form, you agree that IF requested by one of our clients, any charge of the below expenses incurred in verifying your qualifications and/or equipment need for work will be charged back to you. We will inform you prior to doing any verifications or charging you for conducting verifications.

Important information regarding our Payroll Process

This document is important information regarding our payroll process. Fuze HR Solutions is happy to have you join our team and we want to make sure once your employment starts that you receive your pay on a weekly basis with no interruptions (on Fridays throughout the day). The fastest and easiest method of pay is by direct deposit.

All direct deposit information must be provided to our office upon registration. Delay providing direct deposit forms will result late payment until the following pay period once payroll is closed Tuesday of each week.

Important Information: Reimbursement of safety equipment

In order to comply with its obligations under Article 51 of the Health and Safety Act, Fuze HR Solutions has implemented a reimbursement policy for safety equipment. Fuze HR Solutions Inc. is committed to providing our employees with the necessary safety / protection equipment free of charge.

Fuze HR Solutions Inc. has been servicing the staffing and recruitment industry since our inception in 2006.

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