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Applicant Information

Full Name

Address
—Please choose an option—AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewan

Phone Number

Email Address

Available Start Date

Position Applied For

Expected Salary

How Did You Hear Of Our Company?

Are You a Citizen of Canada?
—Please choose an option—YesNo

If No, Are You Authorized to Work in Canada?
—Please choose an option—YesNo

Have You Ever Worked for Midland?
—Please choose an option—YesNo

If Yes, When?

Have You Ever Been Convicted of a Criminal Offense for Which a Pardon Has Not Been Received?
—Please choose an option—YesNo

If Yes, Please Provide Details

Education

Highest Level of Education
—Please choose an option—High SchoolAssociate DegreeBachelor's DegreeMasters DegreePhD

School Address
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Education Start Date

Education End Date

Did You Graduate?
—Please choose an option—YesNo

If Yes, What Was Your Degree?

Previous Employment

Company Name

Company Phone Number

Company Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Employment Start Date

Employment End Date

Reason for Leaving

May We Contact Your Previous Supervisor for a Reference?
—Please choose an option—YesNo

Add Previous Employment (Optional)

Company Name

Company Phone Number

Company Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Employment Start Date

Employment End Date

Reason for Leaving

May We Contact Your Previous Supervisor for a Reference?
—Please choose an option—YesNo

Add Previous Employment (Optional)

Company Name

Company Phone Number

Company Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Employment Start Date

Employment End Date

Reason for Leaving

May We Contact Your Previous Supervisor for a Reference?
—Please choose an option—YesNo

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to my employment, I understand that false or misleading information in my application or interview may result in my release.

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