Application for Fishing Designation This application form replaces the applicant interview process when utilized. Natural Resources staff may contact applicants for more information or request a follow up interview as deemed necessary. Please complete all questions and submit before application deadline using one of the methods listed below. Name ________________________________________________________________________________________________ Last First Middle Date __________________________ Registration # _____________________________________ Physical Address ___________________________________________________________________________________ Number Street City Mailing Address ____________________________________________________________________________________ Box City Postal Code Fishing License you are interested in _____________________________________________________________ Please describe your fishing experience. _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ What is your current fishing capacity? Please highlight your access to Boats, Motors, Trailers, fishing gear, etc. _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Do you feel you have adequate access to capital for purchase and/or maintenance of fishing vessels and hear required for this license? _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Page 1 v 1.0 Created March 17, 2015 Have you ever been convicted of any fishing violations? ____ Yes ____ No If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Please list any relevant safety training/certification you currently have. _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Do you currently have any employment outside the fishery? Would you intend to use this license as your exclusive source of income? _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Are you currently fishing any other licenses? Do you plan to fish any other licenses in upcoming seasons? _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Why would you like to be designated to fish this license? _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Signature Please drop off applications or submit via email or fax to the following address by March 26, 2015. Jonathan W. Strickland, Manager, Natural Resources [email protected] Tel. (709) 634-‐9896 Fax. (709) 639-‐3997 Qalipu Mi’kmaq First Nation Band 3 Church Street Corner Brook, NL A2H 2Z4 Page 2 v 1.0 Created March 17, 2015