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KICKSTART RECRUITMENT SERVICES APPLICATION FORM
Do you have any current or valid safety  Yes  No
certification? (i.e. H2S Alive or WHMIS?)
If "Yes”, please list the tickets you possess:
PERSONAL INFORMATION
Name:
Email:
your flight ticket will be sent here
Do you have a criminal record?
 Yes  No
If so, does it affect your ability to obtain or maintain
employment:
Mobile:
Phone:
DOB:
Gender:
 Male  Female
Adress:
CUSTOMER SIGNATURE
The information you provide is collected and managed in
compliance with Freedom of Information and Protection
of Privacy Act (FOIP). I hereby understand that my
personal information may be disclosed to an authorized
employee, agent or contractor of Kickstart Recruitment
Services or Service Canada to assist in determining my
eligibility for programs and service; to monitor, assess
and evaluate the effectiveness of services provided and
to evaluate the results of provincial and federal programs.
City:
Postal code:
QUESTIONS
Name:
Airport you wish to fly out of:
Are you legally entitled to work in  Yes  No
Canada?
Are you a Canadian Citizen, Permanent  Yes  No
Resident, or have Refugee Status?
If "No”, please explain:
Signature
/
Date
D D
/
M M
Y Y
PRIVACY POLICY
Do you have a valid and clean Class 5 or  Yes  No
G Driver’s License with no restrictions
(non-GDL)
If "No”, please explain:
I agree to attend each day as outlined for the duration of
the program. I understand that I will be responsible for
complying with all rules, regulations and guidelines of the
program and meeting all work search expectations. I
understand that Kickstart Recruitment Services will be
responsible for making all prearrangements for my
training including booking flights to Calgary, Alberta,
transportation from the Calgary Airport, arranging shared
accommodations with other program participants for the
duration of the program, in addition to providing preemployment skill development workshops and training
sessions once I have arrived in Red Deer, Alberta. I
understand that I must be ready, willing, and able to learn,
follow instructions, and adhere to the expectations of the
personnel and training instructors contracted or employed
by Kickstart Recruitment Services. I agree to pay a $1000
deposit for the program costs to Kickstart recruitment
services at the time of registering, with the balance due
upon arrival in Red Deer, Alberta. I also understand that
the program costs are non-recoverable for any reason
and forfeited if terminated from program once payment
has been made to Kickstart Recruitment Services.
Has your license ever been suspended or  Yes  No
restricted?
If "Yes”, please explain:
Are you able to pass a pre-employment  Yes  No
drug / alcohol screening?
If "No”, please explain:
Kickstart Recruitment Services inc.
181, 4819C-48th Avenue T4N3J5

Red Deer, AB Canada

www.kickstartRS.com

Tel: 1-403-774-7403