First Name

Last Name

Gender

Male

Female

Other

Are you a Nunavut Beneficiary?

Yes

No

If Yes, please provide your Beneficiary Number (NTI)

Address

Community

Phone Number

Alternative Phone Number

Email Address

Date of Birth

Social Insurance Number (not mandatory)

Are you employed?

Yes

No

If Yes, please provide the name of your employer

Position

Supervisor's Name

Supervisor's Position

Supervisor's Phone Number

Supervisor's Email

Are you vaccinated against COVID-19

Yes

No

Do you have a CURRENT and VALID Class 5's Driver's License?

Yes

No

If Yes, please provide your Driver's License Number (5 DL No.)

If Yes, please also upload a copy

I grant Northern Future Skills Development my permission to use the photographs taken during the training, for any legal use, including but not limited to publicity, copyright purposes, illustration, advertising, and web content. Further more, I understand that no fee or compensation shall become payable to me by reason of such use.

Yes

No

I certify that the information given above is true, correct, complete and understand that it may be subject to verification.

I also certify that I have read the Code of Conduct Policy and willy comply with its directives.

Heavy Equipment - Registration Form