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Name:
Address:
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Valid Drivers License: Yes No Class:
Current First Aid Certificate: Yes No Expires:
WHMIS Certificate:
What position are you applying for? Labour Welder Forklift Machine Operator Brake/Shear Other If Other, please specify:
What machines/equipment have you been trained to operate?
Are you bondable? Yes No Interests, hobbies, sports? How did you find out about us? Newspaper Web Acquaintance Referral Other In the interest of minimizing potential hazard to yourself or others, are you capable of lifting 75 lbs several times a day? Yes No Explain "No" answer:
How did you find out about us? Newspaper Web Acquaintance Referral Other
In the interest of minimizing potential hazard to yourself or others, are you capable of lifting 75 lbs several times a day?
Explain "No" answer:
Education High school - grade and year completed: College / Trade tickets / Certificates:
College / Trade tickets / Certificates:
Previous work experience (last job first) Years at job: Company Name: Phone-Address: Supervisor: Responsibilities:
Years at job: Company Name: Phone-Address: Supervisor: Responsibilities:
By typing your name below, you are stating that the above information is true and accurate to the best of your knowledge.
Date: