Section 1

Date available for work:

How did you find out about us?
 Friend Newspaper Jobsite Other

If "Other":

Last Name:

First Name:

Middle Initial:

Address:

City:

Home Phone:

Fax:

Alternate Phone:

Leave Message With:

Height (ft. -in.):

Weight (lbs):

Email:

Section 2

Are you legally entitled to work in Canada?
 Yes No

Are you of legal age to work in Canada?
 Yes No

Do you have any limitations (e.g. difficulty with heights, tunnels, heavy lifting, confined spaces) which need to be recognized?
 Yes No

If "Yes", explain

Last School Grade completed:

What Year?

Technical Training: Yes No

If "Yes", what program?

Do you have experience as a construction supervisor?
 Yes No

If "Yes", at what level?
 Lead Hand Foreman Supervisor Superintendent

Do you have CSTS (Construction Safety Training System) Training?
 Yes No

Do you have a valid Driver's license?
 Yes No

A reliable vehicle?
 Yes No

Are you the sole driver of your vehicle?
 Yes No

Are you able to work outside city on a daily basis?
 Yes No

Willing to work away from home?
 Yes No

Hourly Rate expected? ($)

Section 3

Have you completed any of the following? (please check below):

WHMIS Training?
 Yes No

Transporting Dangerous Goods training?
 Yes No

Confined Space Entry training?
 Yes No

Leadership Safety Excellence (LSE)?
 Yes No

Fall Protection - End User?
 Yes No

Section 4

Work History (List most recent employer first)

Note - This section is not required if you are uploading a resume.

Section 5

Carpenter Skills

Mark only those activities, equipment and tools with which you have experience. If hired, you will be expected to perform those activities and use the equipment and tools you indicated.

Use "F" for fully experienced or "S" for some experience. Leave blank if you have no experience.

MISCELLANEOUS

Survey (laser, transit, level):

Reading Blueprints:

Install fences, rails, barriers:

Signals (hand, voice):

Are you currently enrolled in an Apprenticeship program?
 Yes No

If "Yes", which Trade?

In which year? (1, 2, 3 or 4)

When was your most recently completed year of study?

Section 6

Pre-Employment Medical Questionaire

The position for which you are applying has job requirements which include:

• Heavy physical activity.
• Frequent climbing of ladders, stairs and scaffolding.
• Heavy lifting.
• Working at heights (possibly 30 meters plus)
• Frequent exposure to dust, heat, and cold.
• Occasional exposure to fumes, chemicals and irritants.

In the interest of employing you in a situation best suited to your capabilities and to minimize potential risks of injury to you, your fellow workers and to the general public, we request the following medical information.

Do you have a heart condition?
 Yes No

Do you have high blood pressure?
 Yes No

Do you have epilepsy?
 Yes No

Are you presently taking any prescribed medication?
 Yes No

Do you have allergies?
 Yes No

If Yes, to what?

Have you ever had back problems?
 Yes No

If Yes, explain:

Do you have any handicap or health condition that would affect your ability to do the job for which you are applying?

If Yes, what functions can you not perform and what accomodations could be made which would allow you to work adequately?

I declare the above information to be accurate and correct to the best of my knowledge. I understand that any omissions or misrepresentations may result in reclassification or dismissal upon review by my employer. I further authorize my employer to obtain a medical evolution by a physical if required.

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