Any information collected from this form will be used exclusivley by Whissell Contracting Calgary Ltd. If you have any questions or concerns contact us by email at careers@whissell.ca Contact Information Last Name: First Name: Home Phone: Cell Phone: Email Address: Address: City/Prov/Postal Code: Employment Information/History Primary Position Applied For: Hours of Experience: Anticipated Starting Date: Anticipated Ending Date: Do you have your own vehicle: Yes No Are you legally entitled to work in Canada: Yes No   Previous Employer: Position: Dates Employed: Duties: Reason For Leaving: Previous Employer: Position: Dates Employed: Duties: Reason For Leaving: References Name: Phone Number: Relationship: Name: Phone Number: Relationship: Name: Phone Number: Relationship: Other Experience and Hours Worked Check the box/boxes beside the position/positions you have experience working in Hours of experience Back Hoe Operator Dozer Operator Excavator Operator Flag Person Foreman Fuel Truck Driver Gradeperson Grader Operator Labourer Lube Man Mechanic (H.D.) Packer Operator Pipelayer Pipelayer's Helper Rock Truck Operator Rubber Tire Loader Operator Scraper Operator Shop Helper Topman Track Loader Operator Water Truck Operator Welder Please read and confirm... The type of work Whissell Contracting offers is physically demanding and involves long hours, the ability to climb, walk on unsteady ground, lift 10lbs, and clearly hear orders given to you by your supervisor during safety meetings in a noisy environment. Are you aware of anything in your circumstance that would cause you to not be able to carry out the duties that you understand of the positions you are applying for? Please Explain: : I authorize Whissell Contracting to make inquiries of all my past employers, Educational institutions and references concerning my prior employment, the Verification of my educational background, and personal character. I further authorize all past employers, educational institutions and all other individuals providing references to respond to verbal and written inquiries from Whissell Contracting regarding my past employment, the verification of my educational background, and personal character. I hereby release all such persons from any liability and damages incurred as a result of furnishing this information. I understand that with respect to Privacy Legislation I will not have access to the information provided by my past employers, educational institutions and references. In the event that Whissell Contracting chooses to hire me, the information collected will be in a sealed envelope contained in my personal file and I will not be granted access to it. If Whissell Contracting chooses not to hire me, the information will be destroyed. I certify that all the information contained in the application is correct. I understand that if I am hired and it is found that this document contains false information that it may result in my immediate dismissal.