Online Application

Submitted by Brainflex on Thu, 04/12/2012 - 22:24

Box 962, Nelson, BC, V1L 6A5
Telephone (250) 229-4709
Fax (250) 229-4759
panosil@telus.net
www.wildfireinterface.ca

FIRE FIGHTING * FORESTRY * SEISMIC * FIRST AID

Please fill out the application form to submit online.
You also have the option to print the application form and send it to us.

Full Name *

Date of Application *

Month

Day

Year

Date of Birth *

Month

Day

Year

Address *

City *

Province *

Postal Code *

Primary phone *

Secondary phone

E-mail *

S.I.N.

What type of position are you seeking? *

Fire

Seismic

Forestry

First Aid

Have you worked for us before? *

Yes

No

When would you be available? *

Month

Day

Year

Experience 1

Company

Location

Position Held

From Date

Month

Day

Year

To Date

Month

Day

Year

Contact Person

Phone

Experience 2

Company

Location

Position Held

From Date

Month

Day

Year

To Date

Month

Day

Year

Contact Person

Phone

Do you have British Columbia medical coverage? *

Yes

No

Do you have medical conditions (asthma, diabetes, blood disorders, etc.)? *

Yes

No

If yes, please explain

Do you have allergies (food, insect, animal, environmental, etc.)? *

Yes

No

If yes, please explain

Do you have limitations - physical or mental? *

Yes

No

If yes, please explain

Have you had a Tetanus shot in the past 5 years? *

Yes

No

I permit Panorama Crew Services Inc. to use my photographic image for marketing purposes. *

Yes

No

Emergency Contact *

Phone *

Other comments and information

The information I have provided is true to the best of my knowledge. *

The information I have provided is true to the best of my knowledge.