* denotes required field
* Coram Office you are applying to: Edmonton Calgary Saskatchewan (Regina)
* Date available for work: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2012 2013 2014
How did you find out about us? Friend Newspaper JobsiteOnline Other
* 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 (for example, 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?
Type of experience? (Type "F" for Fully or "S" for some experience): Commercial Industrial Highway Bridge Residential Oilfield Institutional
* Do you have experience as a construction supervisor? Yes No If "Yes," at what level? Lead Hand Foreman Supervisor Superintendent
* Do you have CSTS training? Yes No
* Do you have a CET Degree? Yes No
* Do you have a valid driver's license? Yes No Class: * Reliable vehicle? Yes No * Are you the sole driver of your vehicle? Yes No
* Are you able to work outside the city on a daily basis? Yes No * Are you willing to work away from home? Yes No
Hourly rate expected? $
* First Aid Certificate? Yes No Expiry Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2012 2013 2014 2015 2016 2017 2018 Type? Standard Emergency Advanced
* H2S Alive Certificate? Yes No Expiry Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2012 2013 2014 2015 2016 2017 2018
* WHMIS Training? Yes No
* Transporting Dangerous Goods training? Yes No
* Home Builders IV? Yes No
* Leadership Safety Excellence (LSE)? Yes No
* Merit STP? Yes No
* Merit CST? Yes No
* Confined Space Entry training? Yes No
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 indicate.
Use "F" for Fully Experienced or "S" for Some Experience. Leave blank if you have no experience or qualifications.
Carpenter's helper Pipefitter's helper Electrician's helper Welder's helper Demolition Drywall Insulation Welding, Cutting Install Paving Bricks Hand Excavation Backfilling Slab Preparation Install weeping tile Small Tool Repair Swamper Scaffold:std. frame Scaffold:tube-clamp Scaffold:swing stage Manlifts (Scissor/JLG) Survey (laser,transit, level)
Framing Sheathing, hoarding Formwork Stripping Formwork Caulking
Vibrator Operator Placing Concrete Pump Hose Screeding Waterproofing
Signals (hand, voice) Blueprint Reading
Tampers Bobcat Compactor Backhoe Air Compressor Jackhammer Small Cat (D4) Forklift Front End Loader Dewatering Pumps Grinders Chippers Install/Maintain Heaters Pneumatic Nailers Cutoff Saw Table Saw Masonry Saw Power Plane Explosive Actuated Tools
Have you completed any of the following Construction Skills Training Courses?
Basics of ConstructionYes No FormworkYes No Small Tools & EquipmentYes No ConcreteYes No Rigging & HoistingYes No Scaffolding/SafetyYes No
Excavation & CompactionYes No Basic Blueprint ReadingYes No Advanced Blueprint ReadingYes No Basic SurveyingYes No Advanced SurveyingYes No Explosive Actuated ToolsYes No
* Do you hold a Construction Labourers Qualification Certificate? Yes No Ticket Number
* Are you currently enrolled in an Apprenticeship program? Yes No Which trade? In which year? (1, 2, 3 or 4) When was your most recently completed year of study?
I consent to Merit Contractors Association disclosing the information contained in this application form to prospective employers. I understand that the Association does not promise me employment and that the information will not be distributed to any other non-Merit member third party. I further understand that the Association retains the right to terminate my registration if I fail to report changes in my work status, if I receive unsatisfactory performance evaluations, or for any other reason. I certify that the statements made by me are true and complete. I also understand that a false statement may disqualify me from employment or result in dismissal.
Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2012
