Employment Application - Executive Assistant/ Administrative Assistant Survey

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1. Contact Information

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code

Country *

Email Address *

Phone Number *

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2. Employment Data

	Yes	No
Do you have a valid driver's licence?	Do you have a valid driver's licence? Yes	Do you have a valid driver's licence? No
Have you completed Grade 12?	Have you completed Grade 12? Yes	Have you completed Grade 12? No
Do you have at least 1 year of experience in an Executive Assistant or Administrative Assistant role?	Do you have at least 1 year of experience in an Executive Assistant or Administrative Assistant role? Yes	Do you have at least 1 year of experience in an Executive Assistant or Administrative Assistant role? No
Have you had previous work experience with handling highly sensitive or confidential information?	Have you had previous work experience with handling highly sensitive or confidential information? Yes	Have you had previous work experience with handling highly sensitive or confidential information? No
Have you held a position where you were responsible for managing the calendars of other people?	Have you held a position where you were responsible for managing the calendars of other people? Yes	Have you held a position where you were responsible for managing the calendars of other people? No
Are you legally entitled to work in Canada?	Are you legally entitled to work in Canada? Yes	Are you legally entitled to work in Canada? No
Have you ever been convicted of a criminal offence for which you have not been pardoned?	Have you ever been convicted of a criminal offence for which you have not been pardoned? Yes	Have you ever been convicted of a criminal offence for which you have not been pardoned? No

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3. What position are you applying for?


Executive Assistant	Executive Assistant
Administrative Assistant	Administrative Assistant

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4. Language proficiency in French

	None	Basic	Intermediate	Advanced
Speaking	Speaking None	Speaking Basic	Speaking Intermediate	Speaking Advanced
Reading	Reading None	Reading Basic	Reading Intermediate	Reading Advanced
Writing	Writing None	Writing Basic	Writing Intermediate	Writing Advanced

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5. If hired when can you begin work?

Date / Time

Date

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6. Expected Salary (Please provide a number, or a range of numbers)

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7. Education History and Certifications
In the spaces below, please list all secondary and post-secondary institutions attended along with diploma/degree obtained and date completed:

Institution

Degree/Diploma

Date Completed

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8. Education History and Certifications

Institution

Degree/Diploma

Date Completed

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9. Education History and Certifications

Institution

Degree/Diploma

Date Completed

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10. Please list any professional licences or certificates obtained (if applicable):

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11. Employment History - Company 1
Please list most relevant experience only

Employer

Address

Phone

Supervisor

Your job title

Employment dates (From ___ To ____)

Responsibilities

Reason for leaving

May we contact this employer? (Yes/No)

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12. Employment History - Company 2
Complete if possible

Employer

Address

Phone

Supervisor

Your job title

Employment dates (From ___ To ____)

Responsibilities

Reason for leaving

May we contact this employer? (Yes/No)

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13. Employment History - Company 3
Complete if possible

Employer

Address

Phone

Supervisor

Your job title

Employment dates (From ___ To ____)

Responsibilities

Reason for leaving

May we contact this employer? (Yes/No)

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14. Computer Proficiency
Please indicate how much computer experience you have with the following:

	None	<1 year	1-2 years	3-4 years	5+ years
MS Word	MS Word None	MS Word <1 year	MS Word 1-2 years	MS Word 3-4 years	MS Word 5+ years
MS Excel	MS Excel None	MS Excel <1 year	MS Excel 1-2 years	MS Excel 3-4 years	MS Excel 5+ years
MS Office Calendar	MS Office Calendar None	MS Office Calendar <1 year	MS Office Calendar 1-2 years	MS Office Calendar 3-4 years	MS Office Calendar 5+ years
MS Power Point	MS Power Point None	MS Power Point <1 year	MS Power Point 1-2 years	MS Power Point 3-4 years	MS Power Point 5+ years
Jonas	Jonas None	Jonas <1 year	Jonas 1-2 years	Jonas 3-4 years	Jonas 5+ years

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15. Reference 1
Please list three professional references. Preferably direct supervisors - no clients

Full Name

Company

Address

Job Title

Phone

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16. Reference 2

Full Name

Company

Address

Job Title

Phone

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17. Reference 3

Full Name

Company

Address

Job Title

Phone

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18. I certify that the information provided in this application is true and complete to the best of my knowledge. I also realize that this information may be verified and that any misrepresentation of the facts and any false, misleading, or incomplete information in my application or interview may constitute grounds for immediate dismissal from employment.

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1. Contact Information

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2. Employment Data

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3. What position are you applying for?

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4. Language proficiency in French

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5. If hired when can you begin work?

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6. Expected Salary (Please provide a number, or a range of numbers)

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7. Education History and Certifications In the spaces below, please list all secondary and post-secondary institutions attended along with diploma/degree obtained and date completed:

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8. Education History and Certifications

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9. Education History and Certifications

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10. Please list any professional licences or certificates obtained (if applicable):

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11. Employment History - Company 1Please list most relevant experience only

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12. Employment History - Company 2Complete if possible

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13. Employment History - Company 3Complete if possible

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14. Computer ProficiencyPlease indicate how much computer experience you have with the following:

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15. Reference 1Please list three professional references. Preferably direct supervisors - no clients

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16. Reference 2

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17. Reference 3

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7. Education History and Certifications
In the spaces below, please list all secondary and post-secondary institutions attended along with diploma/degree obtained and date completed:

11. Employment History - Company 1
Please list most relevant experience only

12. Employment History - Company 2
Complete if possible

13. Employment History - Company 3
Complete if possible

14. Computer Proficiency
Please indicate how much computer experience you have with the following:

15. Reference 1
Please list three professional references. Preferably direct supervisors - no clients