Application For 2017 Courses

 NOTE: Please print in ink

Name: Last ____________________First _________________Middle Initial ____________

Address

_____________________________

 

 

 

 

_____________________________

 

 Age

______________________________

 

_____________________________

 

 Sex

______________________________

 

_____________________________

 

 D.O.B

______________________________

Phone

_____________________________

 

 

 

 

START DATE:    

August 8th  2017

END

DATE:

October  28th, 2017

 

 Email Address:___________________________   Phone:______________________

EMERGENCY CONTACT:

Phone:_________________________ Name:________________________________

*Please note that this is an application only, it will be used for the sole purpose of holding your position in the Commercial Diving Program.  Upon arrival you will be given a binding contract to review and sign.

Application fee should be sent along with application to hold a position. Photocopies of C.P.R., First Aid, SCUBA Certification and Diving Medical must be received prior to the start date, along with proof of grade 12 or equivalent.

 Category "1" Commercial Diver 12 week course. Cost: $20,200.00 Canadian Dollars

 Books $300.00 Canadian Dollars, Room and Board Separate Package $4500.00 Canadian Dollars

 All statements are true to the best of my knowledge./Providing false information may lead to expulsion

 

_______________________________________

 

_______________________________________

Signature

Date

 

PLEASE MAIL APPLICATIONS TO: CANADIAN WORKING DIVERS INSTIUTE

P.O. BOX 640, CHAPLEAU ONTARIO, P0M 1K0

 

REVISED OCTOBER 2015