Name *
E-mail *
Street
City
Province:	-- choose -- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Postal / Zip Code
Telephone #
Do you possess a Social Insurance Number?
Yes No
Are you eligible to work in Canada?
Yes No
Farm Housing Required:
Yes No
Are you returning to school in September:
Yes No
Can you lift 50 lbs or more?
Yes No
Can you climb an 8 ft ladder?
Yes No
Do you have your own reliable vehicle:
Yes No
Do you possess a valid driver's license:
Yes No
If yes what class?
Types of Agricultural work previously done and number of years/months experience:
Types of farm equipment and machinery used and number of years/months experience:
Select the agricultural jobs you would prefer (even if you have never done them before): Harvesting Fruits/Vegetables Packing Fruits/Vegetables Thinning Grape Tying Grape Pruning Tree Pruning Greenhouse Nursery Equipment Operating Landscaping Cash Crops Livestock General Labour
Length of Employment Desired: Day Work - 1 to 5 days Full Season - 1 week to 6 months Permanent - Year round