Concord Well Servicing - Alberta

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Required Fields *

Step 1 of 7: Personal Information

Date:	* (dd/mm/yyyy)
Position Applied For:	* (view job listings)
First Name:	*
Last Name:	*
Initials:
Email Address:
Phone Number:	*
Date of Birth:	Day:Month: Year: *
Address:	*


City:	*
Province:	*
Postal Code:	* (eg. T0L0K0)
* How did you hear about us?

Attach Resume:
If resume is attached, skip to step 7 of 7.

Step 2 of 7: Training

Training in: (Include expiry date or ticket # if applicable)

First Aid:	Ticket #:	Exp:
First Line BOP:	Ticket #:	Exp:
Second Line BOP:	Ticket #:	Exp:
H2S Alive:	Ticket #:	Exp:
TDG:	Ticket #:	Exp:
WHMIS:	Ticket #:	Exp:
GODI:	Ticket #:	Exp:
Confined Space:	Ticket #:	Exp:
Fall Protection:	Ticket #:	Exp:
Rig Rescue:	Ticket #:	Exp:
LEL:	Ticket #:	Exp:
Boiler Cert:	Ticket #:	Exp:
CAODC Cert:	Ticket #:	Exp:

Step 3 of 7: Drivers License Information

Do you hold a current driving license?	Yes No
If so, please give the following information:
Driver License Number:	*
Expiration Date:	*
Province of Issue:	*
Highest Class of License:	*

Step 4 of 7: Education

Name of School:	*
Date Last Attended:	*
Type of Certificate or Diploma obtained:	*
Further Education:

Step 5 of 7: Employment History (Present or Most Recent Employer First)

NAME	POSITION	DATES WORKED	REASON FOR LEAVING	SALARY
1.
2.
3.

If employed, how soon could you start?
Please give the names of any friends or relatives employed by us and their positions:

Have you worked for Concord Well Servicing in the past?	Yes No
Where?
What were your duties?

Who was your immediate supervisor?
Please state the reason for leaving:

Step 6 of 7: Physical Considerations

Do you have any physical considerations that would require special accommodations for you to complete heavy labour work (ie. Lifting, bending, long hours, etc.)	Yes No
If so, please list:

Step 7 of 7: Verify Information Accuracy

By Typing ACCEPT in the following box, I certify that all the information in this application is true and complete. If accepted for employment, I understand that I am required to wear personal protective equipment at all times while working and I will also abide by policies and procedures of the company.

Until final acceptance of this application, employment shall be considered temporary. The company reserves the right to cancel employment of any applicant upon proof of misrepresentation in the application, upon receipt of unsatisfactory references, upon failure to pass any prescribed physical examination, any evidence of consuming alcohol when reporting for work or upon any act of dishonesty. I understand it may be necessary to complete reference checks with my previous employers prior to being requested to attend and interview. Any position of employment within the CONCORD WELL SERVICING organization is subject to compliance with all company policies.

All information collected by application or upon hire is for the establishment and management of employment with CONCORD WELL SERVICING. Information provided will only be disclosed by the Company for purposes of securing client business (ie. Bid Resumes), benefits administration, Workers' Compensation benefits or emergencies. Any other requests for disclosure of information will require express written or verbal consent from the employee pursuant to the Personal Information Privacy Act (Alberta).

I verify that all of the above information is true and correct, to the best of my knowledge.

I ACCEPT: *

CONCORD WELL SERVICING realizes that substance abuse is a social and workplace issue. The Company believes that employers and employees should take an active role to address substance abuse in the workplace and to assure a safe and healthy work environment.

Accordingly, CONCORD WELL SERVICING has adopted a Drug and Alcohol Policy which includes education and prevention. All employees are subject to all company policies, including the aforementioned.