website: www.synovateconsulting.

com

APPLICATION FOR EMPLOYMENT

Date of Application: / /
PLEASE FILL OUT THE FORM IN BLOCK LETTERS. KINDLY MAKE SURE THAT THE WRITING IS LEGIBLE. ALL OF THE INFORMATION FROM THIS DOCUMENT WILL BE CONFIDENTIAL AND NOT AVAILABLE TO THIRD PARTIES. PLEASE READ BEFORE YOU COMPLETE APPLICATION 1. All of our positions require that you be at least 21 years old and have proof of your education. (High School, GED or College Transcript) 2. Please complete all sections of the application form as the information provided on this form will be used as part of the election process. 3. Incomplete applications will not be considered for employment. 4. If questions are not applicable, enter NA

PERSONAL DETAILS Date of Birth: 01/22/84 Full Name: Kevin Paisley Address: Gender: Male Female

Vacancy Details Reference: 155.196-232 Job Title: Operations Assistant For internal applications: Staff number:

City: Country: ZIP:

Grande Prairie/Peace River Alberta, Canada T0H1W0

Senior Manager: Justin Stewart Where did you see this vacancy advertised? online Have you attached any continuation sheets? Any additional information attached. Yes No

Contact numbers: 17606667801 Home: 17805610141 Mobile: Fax: Email: kevinpaisley@live.com

Are you available to work: Regular Full-time Part-time, Hours:

Mo 6am-8tu6am-9pm We 6am-8pm the Fr 9-9a sat 12-4

Date Available: Are you currently employed? If "YES": Company Name:

/ Yes

/ No

Address:

box1395 prov: Alberta

City: Grimshaw days and times REFERENCES

Please give below the names and addresses of people to whom we may apply for information about your work, experience and attendance record and indicate your relationship. One of them must be your most recent or current employer (if previously employed). If you have just left college, you may supply details of your Head Teacher/Principal. 1 Most recent employer Name: Address: ZIP: Phone: Fax: Email: Can we contact? Yes No 2 Relationship: Name: Address: ZIP: Phone: Fax: Email: Can we contact? Yes No 3 Relationship: Name: Address: ZIP: Phone: Fax: Email: Can we contact? Yes No

I certify that the above information (and any further information enclosed) is correct and I agree that the Employer may take reasonable steps to verify this information (e.g. by obtaining proof of qualifications). I agree to the Employer processing and retaining the personal information contained on this form for any purposes connected with my application. EMPLOYEE Signed Kevin Paisley

I confirm that all of your information is confidential and will not be available to any third parties. HR CHIEF EXECUTIVE JAMES W. DARDEN Signed