Membership Application Once we have reviewed your application, if we think you're a good fit with LIUNA, we will contact you. MultipageStep 1 of 8 Personal Information First Name * Last Name * Sex * Male Female Age * Address * City/Town * Province * - Select a value -OntarioBritish ColumbiaAlbertaSaskatchewanManitobaQuébecNew BrunswickNova ScotiaPrince Edward IslandNewfoundland Postal Code * Home Phone * Cell Phone Email * Social Insurance Number Do you have a driver's license? * Yes No License # Classification If no, explain why Do you have an automobile? * Yes No Are you currently a member of any union? * Yes No If yes, which union? 1 / 8 Step 2 of 8 Personal History Any injuries or disabilities? * Yes No WSIB * Yes No Have you made a previous claim? * Yes No Do you have any physical restrictions? * Yes No If yes to any of the above, please explain 2 / 8 Step 3 of 8 Education Are you currently in school? * Yes No If yes, what is the name of the school? Name of the program? Elementary School History Elementary School Level Reached (Degree, Diploma, Certificate, License) Elementary Institution Year Obtained Secondary School History Secondary School Level Reached (Degree, Diploma, Certificate, License) Secondary Institution Year Obtained College History College Level Reached (Degree, Diploma, Certificate, License) College Institution Year Obtained University History University Level Reached (Degree, Diploma, Certificate, License) University Institution Year Obtained Other Training (On-the-job, volunteer, apprenticeship) 3 / 8 Step 4 of 8 Language and Mathematics What is your first language? * What other languages do you speak? Ability to read English * Poor Fair Good Excellent Ability to write English * Poor Fair Good Excellent Ability to speak English * Poor Fair Good Excellent Can you add, subtract and multiply whole numbers? * Yes No Can you add, subtract and multiply fractions and decimals? * Yes No Can you find the area of a circle, triangle, square, etc? * Yes No Rate your ability working with imperial measurements * Poor Fair Good Excellent Rate your ability working with metric measurements * Poor Fair Good Excellent 4 / 8 Step 5 of 8 Work ExperienceMost Recent Employer Company 1 Date 1 Empty 'End date' values will use the 'Start date' values. Date E.g., 12/13/2018 to: Date E.g., 12/13/2018 Job Duties 1 Reason for Leaving 1 Contact for Reference 1 Previous Employer Company 2 Date 2 Empty 'End date' values will use the 'Start date' values. Date E.g., 12/13/2018 to: Date E.g., 12/13/2018 Job Duties 2 Reason for Leaving 2 Contact for Reference 2 Previous Employer Company 3 Date 3 Empty 'End date' values will use the 'Start date' values. Date E.g., 12/13/2018 to: Date E.g., 12/13/2018 Job Duties 3 Reason for Leaving 3 Contact for Reference 3 Previous Employer Company 4 Date 4 Empty 'End date' values will use the 'Start date' values. Date E.g., 12/13/2018 to: Date E.g., 12/13/2018 Job Duties 4 Reason for Leaving 4 Contact for Reference 4 Previous Employer Company 5 Date 5 Empty 'End date' values will use the 'Start date' values. Date E.g., 12/13/2018 to: Date E.g., 12/13/2018 Job Duties 5 Reason for Leaving 5 Contact for Reference 5 If you have construction experience, please indicate your specific skills 5 / 8 Step 6 of 8 Employment Insurance Are you currently receiving E.I. benefits? * Yes No Do you have enough hours to file for an E.I. claim? * Yes No Have you received E.I. benefits within the last three (3) years? * Yes No Have you had training through HRDC or MTCU in the past? * Yes No If yes, when? 6 / 8 Step 7 of 8 Criminal Convictions Have you ever been convicted or found guilty by a court of any criminal offence in any country? * Yes No Are there any criminal actions pending against you in any country? * Yes No If yes, please explain (charges, date, country, etc.) 7 / 8 Step 8 of 8 Garnishments Do you owe any amount to the Government of Canada under legislation or contribution agreements? * Yes No (i.e. arrears for child support payments, E.I. overpayments, income tax, etc.) Vertical Tabs 8 / 8 Leave this field blank