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Electrical Maint Application - Enform

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					                                                   For Enform Use Only:
                                                   Application Approved: Yes          No  Date              Signature:




                          ELECTRICAL MAINTENANCE TRAINING
                               — APPLICATION FORM —
    Note:      For completion only by candidates wishing to register in the Enform Electrical Maintenance
               Training course. This 2½-day course has been developed to meet the criteria for non-electricians
               to perform limited tasks which comply with Section 24 of the Apprenticeship and Industry Training
               Act.
                   Successful applicants must be currently employed and have at least 3 years
                                 of work experience in the petroleum industry.

                                       PART A: Personal Information
             Please complete all information requested (PLEASE PRINT CLEARLY).

                                                                          COURSE DATE:
                                                                          ___________________
Social Insurance Number (optional):              Driver’s License Number: (optional)                  Date of Birth (month/day):


Surname:                                                          Usual First Name and Initial:


Company:


Mailing Address:                                                                   City:                             Province:


Postal Code:                    Telephone Number:                                  Facsimile Number:
                                (           )                                      (              )
Are you physically capable of performing electrical maintenance work?
   Yes           No


                                          PART B: Industry Experience.
What is the total period of time that you actively participated in the maintenance of petroleum industry related equipment in the past
36 months (3 years)?
                Years                            Months
List your maintenance experience below, starting with the most recent employer.
1. Employer:                                                                  Telephone Number:
                                                                              (            )
Address:


Job Title:                                                                    Date Started:                   Date Ended:


Description of Duties:




                          PLEASE COMPLETE THE REVERSE SIDE OF THIS APPLICATION
                                                           Page 1 of 2                                               October 2009
2. Employer:                                                                     Telephone Number:
                                                                                 (         )
Address:


Job Title:                                                                       Date Started:               Date Ended:


Description of Duties:




I hereby make application for the Enform Electrical Maintenance Training course. I understand
that information provided on this application is material to being accepted into the course, and
that any inaccuracy or misrepresentation is sufficient reason for Enform to suspend or revoke any
training certificate issued to me pursuant to this application.



Candidate’s Signature:                                                                           Date:




         PART C: Proof of Sponsorship (TO BE COMPLETED BY THE EMPLOYER)
I certify that the candidate named and described in Part A of this application has actively worked under my supervision for a time
period of         year(s) and            month(s) within the past 36 months (3 years).

I have read Part B of this application, and believe the information provided by the applicant is accurate. Based on my
understanding of the applicant’s experience, knowledge and abilities, I am sponsoring this individual to work within the CAPP
guidelines for electrical maintenance work for on-electricians, as described within the scope of the training. I understand that it is
my responsibility to provide the applicant with company specific training for the equipment and procedures he/she will be using.
Name (please print):                             Signature:                                        Date:


Job Title:                                       Company:


Telephone Number:                                               Facsimile Number:
(            )                                                  (            )


Return completed Application Form to:
                                                          Enform
                                                  1538 - 25 Avenue N.E.
                                                  CALGARY, AB T2E 8Y3
         Phone: (403) 250-9606             Toll-Free: 1 (800) 667-5557 Facsimile:(403) 291-9408




                                                    www.enform.ca
    O:\Training Course Materials\Technology & International\Electrical Maintenance\Electrical Maint App Oct 2009.doc




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