1.  Date:

2.  Please provide the following contact information:

      Name

      Work phone

      Home Phone

      e-mail address

3.   What line of work do you perform?  Select Instr. Technical Instr. Fitter Electrical Technical Electrical Basic Electrical & Instrumentation

4.   Do you have formal training in your related craft? Select Yes No

5.   If yes, Where?

6.   Did you graduate? Select Yes No

7.   Are you a previous Westgate employee?   Select Yes No

8.   If Yes, When?

9.   Number of years experience:

10.  Are you currently employed? Select Yes No

11.  With Whom (optional):

12.  Do you have a current Safety Council Card? Select Yes No

13.  Will you travel? Select Yes No

       Comments:

Disclaimer: This form is in no way an employment application.