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Application For Employment

BLUENOSE II

Personal Data

Last Name / First Name / Middle Name(s)
Current Address / City/Town
Province / Postal Code
Home Address / City/Town
Province / Postal Code
Current email address: / Cell Phone:
Home Phone: / Day Phone:

Employment Information

Are you a Canadian Citizen? / Do you posses a valid Canadian Passport?
If hired when can you start? / Do you possess a valid TC Seafarers Medical?
Do you possess a valid M.E.D. A2 Certificate? / Do you possess a Marine First-Aid Certificate?
What is your age as of April 1?
Please list the sailing vessels you have worked on and what your rank and duties were.
Other specialized training,awards, designations etc.

Work History

(Last three jobs)

List in order beginning with your most recent job (or present job if currently employed).

Present or last Employer(1) / Address of employer
Type of business
Job Title / From (Mo/Yr) / To (Mo/Yr) / Final Salary
Name and title of immediate supervisor / Reason for leaving
Describe job duties and responsibilities
Previous Employer(2) / Address of employer
Type of business
Job Title / From (Mo/Yr) / To (Mo/Yr) / Final Salary
Name and title of immediate supervisor / Reason for leaving
Describe job duties and responsibilities
Previous Employer(3) / Address of employer
Type of business
Job Title / From (Mo/Yr) / To (Mo/Yr) / Final Salary
Name and title of immediate supervisor / Reason for leaving
Describe job duties and responsibilities

Please Read Carefully

The foregoing is correct to the best of my knowledge. I understand that deliberate misrepresentation may disqualify me from employment or be cause for dismissal. If hired, I agree to abide by all rules and regulations of Bluenose II, including serving an initial probationary period of 8 weeks.

If I choose to fill this form and submit it as an attachment to an email, I also understand that if I am called for an interview, I may be asked to sign the form at that time.

Applicant Signature ______ Date______