First Name Middle Name Last Name Email address Mailing Address City Province Postal Code Home Phone Cellular Phone SIN: please upload a copy of your SIN card or letter Date of Birth: Banking info: please upload a copy of your void cheque or direct deposit information Medical info: please upload a copy of your full medical card Covid Immunization Card: please upload a copy of your Covid Immunization card or a picture of your digital copy Drivers Lic: YesNo YES or No (do you have one) if yes please upload a copy of your Divers License, I hereby agree and understand that Sigfusson Northern will obtain copies of my driving records and status from variousprovinces for purposes of employment, updating records and insurance. This consent shall be a continuing consent throughout the period during which I am employed with SNL or associated companies. Drivers Class: Emergency Contact Name: Emergency Contact relationship: Emergency Contact number: Voluntary Self Declaration. Status First Nation, Non-Status First Nation, Metis, Inuit , if yes to any please upload a copy of your status card, (required info on this page will be Treaty Name, Location and number) Medical Information: Are you physically fit to do the duties you were hired for?Do you have any medical condition(s) that could affect you on this job?Do you take medication that should be listed on your file for emergency situations?Do you have any pre-existing conditions that first responders should know in an emergency?Do you have any allergies that could affect you on this job? I hearby acknowledge that all information that I have provided is true and I agree to all of the following: Permission for SNL to obtain a criminal record check if requiredPermission for SNL to obtain a medicalPermission for SNL to obtain a drug/alcohol testPermission for SNL to obtain a driver’s license verification or abstractPermission for SNL to request my Covid-19 Vaccination information Electronic signature: Date:
