Application For Employment
Date of Application: .............................................

Personal Information

Last Name: ......................................................................................... Middle Initial: .............................................. First Name: ....................................................................
Address: .............................................................................................. City: ...............................................................................................................................................................
Province: ............................................................................................. Postal Code: ................................................ Home Phone #: ............................................................
Alternate Telephone #: .................................................................. E-mail: ...........................................................................................................................................................
Have you worked at Wal-Mart/SAM’S CLub before: o No o Yes

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

Position
Position applying for: ................................................................................................................................................... o Seasonal /Temporary ...........................................
Are you interested in:

o Full Time (Min. of 28 hrs per week)

o Peak Time (Less than 28 hrs per week)

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

Availability
Date available to start (dd/mm/yyyy): ...................................................................................................................................................................................................................
Indicate when you are available to be scheduled (specify a.m. or p.m.). Due to the nature of our business, the more available you are, the more opportunities we can consider you for.
Saturday

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

From
To
Overnight yes/no

Education
Tell us the highest or equivalent level completed
Institution Type Completion

Type of Certification/Diploma/Degree Received

High School Year Completed o 1

o2

o3

o4

o5

Post Secondary o 1

o2

o3

o4

o5

Reference Check Consent
Please provide at least 2 work-related references Wal-Mart may contact in the spaces below. List most recent employers, managers, supervisors only.
DO NOT list family and friends.
Supervisor’s Name: ............................................................. Position Title: .............................................. Name of Company: ....................................................
Address: ...............................................................................................................................................................................................................................................................
Can we contact them: ....................................................... Phone Number: ......................................... Your Position: ...............................................................
Date of Employment: ......................................................... Reason for Leaving: .................................. Duties: ..............................................................................

2

Supervisor’s Name: ............................................................. Position Title: ..............................................