Reference program

You know someone looking for a job? Refer this person to us!

Candidate referred

(*.doc, *.docx, *.rtf or *.pdf only)
(*.doc, *.docx, *.rtf or *.pdf only)

Consent form for the collection, use and retention of personal information

Please read the information below and tick the box indicating your consent.

Date: 2024-07-12

Agri-Marché Inc.
236 Ste-Geneviève
Saint-Isidore, Quebec
G0S 2S0

Candidate’s name:


Agri-Marché Inc. wishes to use your personal information to create a job applicant file specific to you. This data will be used to fulfil the company’s obligations to you in connection with your application.

To do so, Agri-Marché Inc. must obtain your consent to collect your personal information.


    To manage your application, Agri-Marché Inc. needs to collect various pieces of personal information that can be used to identify you.

    By submitting your application or sending in your résumé, either in paper form or electronically, you consent to the collection of that personal information. Please read all the information in the form.


    Personal information is required for Agri-Marché Inc. to fulfil its obligations to you in connection with a job application and hiring process.


    Under the Act,1 the information listed below is personal information: it relates to you and allows you to be identified.

    • Last name
    • First name
    • Home address
    • Home telephone number
    • Cell phone number
    • Personal email address
    • Date of birth
    • Driver’s licence number
    • Health insurance number
    • Social insurance number
    • Passport number
    • Salary
    • Function/occupation
    • Biometric data
    • Information about employees, clients or beneficiaries
    • Medical information
    • Genetic information
    • School/academic information
    • Banking information/account number/institution/investments/mortgage
    • Credit card number/personal identification number (PIN)/cardholder’s name/three-digit security code
    • Debit card number/personal identification number (PIN)/cardholder’s name

    Agri-Marché Inc. undertakes to use security measures to ensure the confidentiality of the above-mentioned information when it is collected.


    Agri-Marché Inc. will not disclose your personal information to anyone, except as required for a third party to provide services or for the purpose of obtaining references, to which you must give prior consent.

    In such cases, Agri-Marché Inc. enters into a contract or confidentiality agreement with the third party to ensure that appropriate security measures are put in place and maintained. The third party may have access to your personal information and to identifying information, but only to the extent required to execute a mandate or contract.


    Your personal information will be retained until the end of the hiring process.

    In the event that your application is unsuccessful, Agri-Marché Inc. will securely destroy your personal information as soon as possible, including any information that may have been accessed by third parties providing services.


    As with all your personal information, you may request access to or rectification of your personal information.

    To do so, send a request in writing to the officer responsible for access to documents and protection of personal information at Agri-Marché Inc. at the following address:

    236 Ste-Geneviève
    Saint-Isidore, Quebec
    G0S 2S0

    Agri-Marché Inc. must respond to your request for access, rectification or information within thirty (30) days of receipt.


    I, , hereby confirm that I have read this form and its appendix and that I understand the information regarding the collection, use and retention of my personal information by Agri- Marché Inc.

    I understand that Agri-Marché Inc. will use my personal information solely for the purpose of fulfilling its obligations to me in connection with a job application process.

    I consent to the collection, use and retention of my personal information as outlined in this form.

    1  Act respecting the protection of personal information in the private sector