Application for Employment

APPLICATION FOR EMPLOYMENT

NORTHERN MINE BOX 9999 La Ronge, SK S0J 1L0 CONFIDENTIAL WHEN COMPLETED
PLEASE PRINT LEGIBLY OR TYPE
Position or Work Desired			Location Desired
Regular Temporary Summer Part-Time Other Specify		Resume Attached Yes No	Date of Application Date Available
			Salary Required Per Hour Salary Required Per Annum
PERSONAL DATA
1. Last or Family Name			2. First or Given Name Used and Initial
3. Address Postal Code			4. Telephone-Home
			Telephone-Business
			or Leave Message With
5. Have you been employed before by this Company before?
Yes No		Dates (From -To)	Position Held
6. Do you have any personal acquaintances in our employ?
Yes No		Name	Position Held
7. Are you legally entitled to work in Canada? Yes No			8. Do you meet the Canadian Nuclear Safety Commission minimum requirement age of 18? Yes No
9. List volunteer experience including offices held, hobbies, and interests. You may exclude organizations that would reveal your race, religion, sex, age or marital status.
EDUCATION
10.a) ELEMENTARY/HIGHSCHOOL. Name of last school attended:			b) Number of years successfully completed:
c) City, Province (Country if outside Canada):
11. TRADE, TECHNICAL SCHOOL, COMMUNITY COLLEGE
NAME OF SCHOOL	CERTIFICATE/DIPLOMA AWARDED	COURSE MAJOR	FROM (Month/Year)	To (Month/Year)



12. UNIVERSITY
NAME OF SCHOOL	DEGREE AWARDED	COURSE MAJOR	FROM (Month/Year)	To (Month/Year)



13. PROFESSIONAL DESIGNATIONS/CERTIFICATIONS/LICENSES
14. TRADE CERTIFICATES
CERTIFICATE		LICENSE NO.	DATE ISSUED	EXPIRY DATE



15. OTHER TRAINING
Mine Rescue Training Yes No	Valid First Aid Certificate Yes No Level Achieved:	Valid Supervisor's Certificate Yes No	Typing Yes No Speed:	Word Processing Yes No
Other Computer Experience Yes No List:	Heavy Equipment/Industrial Operator Experience Yes No List:		Summarize briefly other experience or qualifications.
EMPLOYMENT HISTORY
Begin with the most recent employer. Account for ALL TIME EMPLOYED and RELEVANT prior experience or attach Resume.
Employer:		Position Title:
Address:		Duties:
Supervisor:
Employment Period: Dates (From Month and Year - To Month and Year)
		Number of employees you supervised:
Salary: (Start - Final)		Reason for Leaving:

Employer:		Position Title:
Address:		Duties:
Supervisor:
Employment Period: Dates (From Month and Year - To Month and Year)
		Number of employees you supervised:
Salary: (Start - Final)		Reason for Leaving:

Employer:		Position Title:
Address:		Duties:
Supervisor:
Employment Period: Dates (From Month and Year - To Month and Year)
		Number of employees you supervised:
Salary: (Start - Final)		Reason for Leaving:
REFERENCES
Name	Address	Occupation	Home Telephone:
			Business Telephone:
Name	Address	Occupation	Home Telephone:
			Business Telephone:
Name	Address	Occupation	Home Telephone:
			Business Telephone:
May we refer to your past employers? Yes No		May we refer to your present employer? Yes No
DEFINITION OF A NUCLEAR ENERGY WORKER
Uranium and some elements in the ore with which it is associated are radioactive and the handling of these materials may result in some radiation exposure to the workers. All work with radioactive materials at NORTHERN MINE operations is subject to the control and administration of the Canadian Nuclear Safety commission (CNSC), and their regulations stipulate the radiation dose limits. Persons who work with radioactive materials, and who are likely to receive greater radiation exposure in the course of their employment, compared to the general public, are classified as "Nuclear Energy Workers." A careful check is made on both the workers and their environment on an ongoing basis to protect the health of the employee and NORTHERN MINE will provide cumulative radiation exposure records to each employee on a regular basis.
TERMS OF EMPLOYMENT
1. I understand that any offer of employment will be conditional upon successful completion of a medical examination, where required. 2. I understand that for certain positions, continued employment is contingent upon the satisfactory completion of a security clearance. 3. I give my permission for the corporation to obtain my radiation exposure history from previous employers and/or the National Dose Registry. 4. In the case of female employees: as a female I understand that there are special Canadian Nuclear Safety Commission regulations for radiation exposures of pregnant employees. If I am classified as a Nuclear Energy Worker, I agree to notify NORTHERN MINE immediately in writing, upon becoming aware of the pregnancy. 5. I understand and accept that for certain classes of work it may be necessary to successfully complete training courses. 6. I acknowledge that false statements made on my Employment Application and supporting documentation shall be considered as sufficient cause for dismissal. 7. In accordance with Canada's Personal Information and Electronic Documents Act, any information provided on this form will be kept confidential. This information will be made available to Human Resources personnel, and will be used only to assess your suitability for employment with NORTHERN MINE. 8. I understand that as a condition of employment, I will be required to present a valid social insurance card (or proof of valid SIN number, available from Human Resources Canada) to a Human Resources representative within 3 days of my first day of employment with NORTHERN MINE.
APPLICANT'S SIGNATURE			DATE
OPTIONAL
NORTHERN MINE is COMMITTED TO EQUITY IN EMPLOYMENT. NORTHERN MINE's Employment Equity Program provides equal opportunity for employment to women, visible minorities, people of Aboriginal Ancestry, and persons with disabilities. If you wish to identify yourself as a member of one or more of these groups, you may do so in the space below. If applicable, please specify which functions you cannot perform, and what accommodations could be made to allow you to work adequately.

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