EMPLOYMENT APPLICATION Personal Information Your Name * Date * Address * Your Email * Phone * Job Specific Applying For ---DozerDriver(1/A)Driver(3/D)ExcavatorForemanGarderHeavy Equipment OperatorLabourerLeadhandLight Equipment OperatorLoader OperatorOffice PersonnelTraffic Control PersonnelProject ManagerSupervisorOther Have you previously worked for WCS? ---NoWest-can Seal CoatingSeeley - AnrillWestern Asphalt Where did you hear about WCS? ---Current EmployeeWCS WebsiteKijijiWow JobsIndeedFriendsOther Are you legally entitled to work in Canada? YesNo Type of work applying for (You can select more than one) SeasonalSeasonal, StudentCO-OPFull Time If hired, when would you be available to work? Are you willing to be away from home for long periods of time? YesNo Do you have any pre-planned commitments that would require time away from work in the next 6 months? YesNo Do you have a valid Driver’s License? YesNo If yes, what province is the driver's license issued in? ---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory Class of license? ---Class 1/AClass 1/A with AirClass 3/DClass 3/D with AirClass 5/GClass 5/G with AirClass 5, GDL/G2 Clean drivers abstract? YesNo Education Highest Grade Successfully Completed Education School/Organization Name Course Name Date Obtained Relevant Training / Certificates Training / Certificates Name Expiry Date Experience Most recent first Employer Position Held From Date To Date Wage Rate Reason Left References Name Company Position/Title Telephone Number Resume Attach Your Resume Physical Exertion Almost all construction jobs require physical exertion and/or manual dexterity (bending, twisting, climbing, lifting, shoveling, carrying, repetitive hand motion, hand-eye coordination, remaining in a stationary position for extended periods of time, working in different climates, and working on uneven surfaces) Is there anything that would prevent you from carrying out these activities or working in these conditions? YesNo Acknowledgement I declare that all of the information supplied by me on this application is true and complete to the best of my knowledge. I understand that a false statement may disqualify me from employment or may cause my dismissal. I hereby acknowledge that any offer of employment is conditional upon the passing of a drug and alcohol test as required by the company and shall be administered by a Company approved collection facility. I further acknowledge that any offer of employment may be contingent on a job related medical examination if the Company sees fit. I understand that failure to meet the Company’s standards pertaining to a medical examination is sufficient cause to disqualify me from employment or may be cause for dismissal. Should I refuse the required drug and alcohol testing or refuse medical examination (if required) I acknowledge that such refusal shall be deemed a withdrawal of the above application for employment. Accept Acknowledgement Authorization to Release Information IIn making this application for employment, I authorize the offices or employees of the above noted former employers to release to the Company a complete history of my previous employment with their organization. I acknowledge that the information that may be requested may pertain to wages, tenure, reason(s) for termination and character and work ethic during the course of my employment. . I further authorize any law enforcement agency, administrator, provincial agency, educational institution or private information bureau that has any record or knowledge of my employment history, motor vehicle operation history, criminal record, education, credit or other history records to provide that information upon receipt of this signed release. A telephone facsimile (FAX) or photographic copy of the authorization shall be considered as valid as the original. I release all parties from all liability for any damage that may result from furnishing such information to West-Can Seal Coating Inc. All personal information submitted on this application is confidential, and I hereby consent to the collection and use of such personal information for employment purposes, specifically where such information is necessary to establish, manage or terminate my employment with West-Can Seal Coating Inc. Accept Authorization Certification I certify that the information contained in this application or any other form related to my employment is true and complete to the best of my knowledge. I understand that false or incomplete statements shall be grounds for disqualification or dismissal from the employment, no matter when discovered. Accept Certification