Fillable Personal Data DAYTIME PHONE (+ AREA CODE) EVENING

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Personal Data DAYTIME PHONE (+ AREA CODE) EVENING

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Country of origin: CANADA
File type: PDF

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Personal Data
LAST NAME
FIRST NAME (LEGAL)
MIDDLE NAME (LEGAL)
FORMER/MAIDEN NAME (IF ANY)
PREFERRED NAME / NICKNAME
GENDER
Female Male
BIRTHDATE (YYYY/MM/DD)
DAYTIME PHONE (+ AREA CODE) EVENING PHONE (+ AREA CODE)
STREET or PO BOX ADDRESS
E-MAIL ADDRESS
CITY
PROVINCE
POSTAL CODE
EMERGENCY CONTACT (PERSON’S NAME)
DAYTIME PHONE (+ AREA CODE) EVENING PHONE (+ AREA CODE)
RELATIONSHIP of Emergency Contact to Applicant
Child Friend Parent Sibling Spouse Other Relative
IF YOU WISH TO DECLARE THAT YOU ARE AN ABORIGINAL PERSON, PLEASE SPECIFY:
No Aboriginal Heritage Status Indian/First Nations Non-Status Indian/First Nations Métis Inuit
ALBERTA ADVANCED EDUCATION AND TECHNOLOGY IS COLLECTING THIS PERSONAL INFORMATION PURSUANT TO SECTION 33(C) OF THE FOIP ACT AS THE
INFORMATION RELATES DIRECTLY TO AND IS NECESSARY TO MEET ITS MANDATE AND RESPONSIBILITIES TO MEASURE SYSTEM EFFECTIVENESS OVER TIME AND DEVELOP
POLICIES, PROGRAMS AND SERVICES TO IMPROVE ABORIGINAL LEARNER SUCCESS. For further information or if you have questions regarding the collection activity, please
contact the Office of the Director, Business Operations and Reporting, Post-secondary Excellence Division, Alberta Advanced Education and Technology, 10155-102
Street, Edmonton AB, T5J 4L5, (780) 427-7145 Keyano College, Office of the Registrar.
Freedom of Information & Protection of Privacy (FOIP) Statement
The personal information requested on this form is collected under the authority of Section 33 (c) of Alberta Freedom
of Information and Protection of Privacy Act for the purpose of registering students, contacting students and tracking
enrolment statistics.
Questions concerning the collection, use or disposal of this information should be directed to:
Registrar, Keyano College, 8115 Franklin Avenue, Fort McMurray, AB T9H 2H7 Email: registrar@keyano.ca
Declaration of Applicant
I hereby acknowledge the FOIP statement above, and verify that all information contained on this form is correct to
the best of my knowledge and that no relevant information has been withheld. I agree, if admitted to Keyano College,
to comply with all rules and regulations of the College, and use of information with the FOIP legislation. If admitted to
a collaborative program, I will abide by the rules and regulations of the collaborating institutions. I also authorize
Keyano College to exchange my records with collaborating institutions. I understand that work term
placements are not guaranteed.
The College reserves the right to refuse admission or cancel any admission ruling.
APPLICANT’S SIGNATURE
DATE
Required Documentation to be Submitted with Application
Proof of Grade 12 or GED or international equivalent (official transcripts only)
Photocopy of Driver’s license (valid, unrestricted, at least class 5 or equivalent—not GDL)
Current Driver’s Abstract showing no more than 1 violation within the last 3 years (original document only)
Photocopy of proof of citizenship (passport, birth certificate, citizenship card, or Permanent Resident card)
Career Profile
Current Resume
Prior to Acceptance
Passed DAT (student responsible to book DAT through Office of the Registrar)
Physical Demands test (applicant will be notified when to schedule)
Applicant may be required to verify English fluency
HAUL TRUCK APPLICATION
STUDENT ID#
March 2014
APP RECEIVED BY
OFFICE USE ONLY
DATE
Send
application
by mail or
courier to:
Keyano College
Office of the Registrar
8115 Franklin Ave
Fort McMurray, AB
Canada
T9H 2H7
1-800-251-1408
Tel. (780) 791-4962
Website:
keyano.ca
E-mail:
registrar@keyano.ca
Please
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clearly and
complete
entire form
IMPORTANT
Faxed or
emailed
applications
and
applications
with missing
documentation
will not be
reviewed.
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Personal Data DAYTIME PHONE (+ AREA CODE) EVENING

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Completed 18 March 2021

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