APPLICATION FORM

PERSONAL INFORMATION
LAST NAME FIRST NAME PREFERRED NAME

Roy Sohaib
PRESENT ADDRESS HOME PHONE NUMBER

4104 8 Street
E-MAIL ADDRESS CELL PHONE NUMBER

roysohaib@hotmail.com 7802420977
POSITION OR TYPE OF WORK DESIRED (Name position or top three areas of interest) SALARY OR WAGE DESIRED
$ 30 PER
Laboratory Cordinator DATE AVAILABLE FOR WORK

10-Oct-2018
INDICATE CAREER INTERESTS, SKILLS OR QUALIFICATIONS FLUENT IN
English: Read Write Speak
ISO 17025 French: Read Write Speak
QA/QC (9+ years of experience)

ARE YOU LEGALLY ELIGIBLE TO WORK IN CANADA FOR ANY EMPLOYER? MAY WE CONTACT YOUR CURRENT EMPLOYER?
YES NO YES NO

HAVE YOU EVER BEEN CONVICTED OF A FEDERAL OFFENCE TO WHICH PARDON HAS NOT BEEN YES NO
GRANTED? IF YES, DESCRIBE IN FULL:

HAVE YOU EVER BEEN BONDED? YES NO

IF YES, FOR WHAT JOBS?

IF HIRED, DO YOU HAVE RELIABLE TRANSPORTATION TO AND FROM WORK? YES NO

EDUCATION
YEARS ATTENDED DEGREE, CERTIFICATE,
NAME OF SCHOOL TYPE OF PROGRAM, FIELD OF STUDY,
DIPLOMA, LAST GRADE
AND LOCATION SPECIALIZATION OR MAJOR SUBJECT
FROM TO OR YEAR COMPLETED

HIGH SCHOOL

TECHNICAL, TRADE,
BUSINESS OR
CORRESPONDENCE
SCHOOL

NAIT Chemical Engineering 2007 2010

UNIVERSITY Thunderbay Universitry Chemical Engineering 2007 2010

CONTINUING EDUCATION - NAME OF INSTITUTION PROGRAM OR COURSES

LIST OUTSIDE INTERESTS OR ACTIVITIES, INCLUDING TECHNICAL, TRADE, BUSINESS OR PROFESSIONAL CLUBS, ASSOCIATIONS, ETC.
(OMITTING THOSE OF AN ETHNIC, RACIAL, RELIGIOUS OR POLITICAL NATURE)

HR-2705.004
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 EMPLOYMENT HISTORY
LIST BELOW A RECORD OF EVERY POSITION YOU HAVE HAD, STARTING WITH YOUR PRESENT POSITION AND WORKING BACK.

CURRENT/MOST RECENT EMPLOYER MAY WE CONTACT THIS COMPANY? YES NO

COMPANY START DATE END DATE
NRCan Jan 2018
SUPERVISOR NAME SUPERVISOR EMAIL PHONE NUMBER
Joe Crumbaugh
POSITION/DUTIES

REASON FOR LEAVING STARTING PAY ENDING PAY

PREVIOUS EMPLOYER MAY WE CONTACT THIS COMPANY? YES NO

COMPANY START DATE END DATE
NAIT - COSS July 2014 Dec 2017
SUPERVISOR NAME SUPERVISOR EMAIL PHONE NUMBER
Andrea Sedgewick
POSITION/DUTIES

REASON FOR LEAVING STARTING PAY ENDING PAY

PREVIOUS EMPLOYER MAY WE CONTACT THIS COMPANY? YES NO

COMPANY START DATE END DATE
Endura Manufacturing Co.
SUPERVISOR NAME SUPERVISOR EMAIL PHONE NUMBER
Kalpesh Patel
POSITION/DUTIES

REASON FOR LEAVING STARTING PAY ENDING PAY

HOW DID YOU LEARN ABOUT THIS POSITION?

DO YOU KNOW ANY EMPLOYEES OF AGAT LABORATORIES? NAME DEPARTMENT

YES NO
HAS AN AGAT LABORATORIES EMPLOYEE REFERRED YOU TO THE NAME DEPARTMENT
COMPANY? YES NO
PREFERRED HOURS OF WORK (CHECK ALL THAT APPLY)
FULL TIME PART TIME CONTRACT DAYS NIGHTS AFTERNOONS WEEKENDS

What departments and positions at AGAT Laboratories interest you?

IT CORPORATE ADMINISTRATION LAB ANALYSIS

IT Support Human Resource Geology Reservoir Characterization
IT Development Reception Environmental Services Ultra-trace Toxicology
General Administration Tribology Food Testing
QUALITY ASSURANCE Invoicer Special Core (PVT) Mining Geochemistry
Quality Control Analytical Services Operations Management
Logistics Imaging

FINANCE MARKETING/SALES GENERAL LABOUR FIELD SERVICES

General Accounting Sales/Business Development General Sample Prep Oil and Gas Sampling
Accounts Payable Marketing Mining Sample Prep Source Testing Tech
Accounts Receivable Communications Fire Assay Tech.
Payroll Client Project Manager Shipping/Receiving OTHER
Purchasing /Customer Service General Labour Maintenance
Driver
Summer Student
Co-op/Internship
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 QUESTION
AT AGAT LABORATORIES IT IS OUR MISSION TO PROVIDE “SERVICE BEYOND ANALYSIS.”
IF HIRED HOW WOULD YOU HELP US ACHIEVE OUR MISSION?

Whatever are the duties that will be given to me, i shall finish them before the deadline and perform them at
best. Carry on more task then my job's regular duties. Learn, give, and grow with the company.

INFORMATION AUTHORIZATION

1. I hereby authorize AGAT Laboratories to obtain, subject to all applicable legislation, references whether
from my former employers or otherwise without liability on their part for such disclosure in order to
verify all statements in this application for employment.

2. If accepted for employment, I agree to furnish proof of age and eligibility to work in Canada, social
insurance number, scholastic or occupational certificates/licenses, driver's abstracts or any other
information necessary for personnel records. I also agree to sign a statement dealing with AGAT
Laboratories’ conflict of interest policy, which relates to confidential information and conflict of
interest.

3. I understand that AGAT Laboratories welcomes and encourages applications from people with
disabilities. I also understand that accommodations are available upon request for candidates taking
part in all aspects of the selection and hiring process up to and including a candidate’s employment.

4. In order to ensure the safety of all its employees, AGAT Laboratories may ask for medical
documentation in order to determine if the physical demands of the job are able to be met by an
employee. AGAT Laboratories also reserves the right to request medical documentation for frequent or
prolonged leaves from work due to medical reasons as well as for assessing an employee’s eligibility to
safely return to work. Should my circumstances align with those listed above I agree to provide the
company with the requested documentation, which may include consultation with a company
physician, in order to determine how the company can best accommodate the situation.

5. I hereby certify that the information given in this application is true and accurate. I understand that any
misrepresentation or omissions of fact will result in my employment offer being rescinded or if
employed will be sufficient cause for immediate dismissal.

Date: 09-Oct-2018 Signature:

HR-2705.004
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