ࡱ> % Mbjbj%% )GG]lddddn;n;n;n;; nU=====>>>TTTTTTT$$V DXhU>>">>>UAdd==+(UAAA>.d8==TA>TAACrQLTQM== tY8n;?LQM>U0nULX@HXQMAdddd  WORK EXPERIENCE RECORD APPLICANTS NAME: ____________________________ APPLICATION NO: ____________ (please print) (from front of application) In the space below, provide the name of your current or last employer, your title, and a brief description (one or two sentences) of your job responsibilities. Starting with Application of Geoscience Theory and in order, summarize in detail how your practical geoscience work experience demonstrates how you have satisfied each of the five required criteria (see Schedule B in the Guideline to Registration). Briefly explain how your work experiences have met each of the required exposures (O. Reg. 59/01 amended to O. Reg. 378/01, s. 9.1 (3)). Estimate the percentage of time that you applied to each criterion. If no time was spent, indicate 0%. Repeat the steps above for previous employers, finishing with your first employer. Make copies of each page of this form and include with your reference form sent to each referee. Please enclose the original document with your completed application form. Percentage of Time (see Schedule B) (a) (b) (c) (d) (e) Application of TheoryProcess/SystemsManagementCommunicationsSocietal Implications Name, Title and Address of people most familiar with your relevant experience. Indicate P.Geo. or other professional designation where applicable.Time Period From (month/year) To (month/yearSummary of Experience Employer, Title, Job Description Explain how each required criterion was satisfied.  WORK EXPERIENCE RECORD (continued) Page 2 Percentage of Time (see Schedule B) (a) (b) (c) (d) (e) Application of TheoryProcess/SystemsManagementCommunications Societal Implications Name, Title and Address of people most familiar with your relevant experience. Indicate P.Geo. or other professional designation where applicable.Time Period From (month/year) To (month/yearSummary of Experience Employer, Title, Job Description Explain how each required criterion was satisfied.  WORK EXPERIENCE RECORD (continued) Page 3 Percentage of Time (see Schedule B) (a) (b) (c) (d) (e) Application of TheoryProcess/SystemsManagementCommunications Societal Implications Name, Title and Address of people most familiar with your relevant experience. Indicate P.Geo. or other professional designation where applicable.Time Period From (month/year) To (month/yearSummary of Experience Employer, Title, Job Description Explain how each required criterion was satisfied.  WORK EXPERIENCE RECORD (continued) Page 4 Percentage of Time (see Schedule B) (a) (b) (c) (d) (e) Application of TheoryProcess/SystemsManagementCommunications Societal Implications Name, Title and Address of people most familiar with your relevant experience. Indicate P.Geo. or other professional designation where applicable.Time Period From (month/year) To (month/yearSummary of Experience Employer, Title, Job Description Explain how each required criterion was satisfied.   WORK EXPERIENCE RECORD (continued) Page 5 Percentage of Time (see Schedule B) (a) (b) (c) (d) (e) Application of TheoryProcess/SystemsManagementCommunications Societal Implications Name, Title and Address of people most familiar with your relevant experience. Indicate P.Geo. or other professional designation where applicable.Time Period From (month/year) To (month/yearSummary of Experience Employer, Title, Job Description Explain how each required criterion was satisfied.   WORK EXPERIENCE RECORD (continued) Page 6 Percentage of Time (see Schedule B) (a) (b) (c) (d) (e) Application of TheoryProcess/SystemsManagementCommunications Societal Implications Name, Title and Address of people most familiar with your relevant experience. Indicate P.Geo. or other professional designation where applicable.Time Period From (month/year) To (month/yearSummary of Experience Employer, Title, Job Description Explain how each required criterion was satisfied.   WORK EXPERIENCE RECORD (continued) Page 7 Percentage of Time (see Schedule B) (a) (b) (c) (d) (e) Application of TheoryProcess/SystemsManagementCommunications Societal Implications Name, Title and Address of people most familiar with your relevant experience. Indicate P.Geo. or other professional designation where applicable.Time Period From (month/year) To (month/yearSummary of Experience Employer, Title, Job Description Explain how each required criterion was satisfied.   WORK EXPERIENCE RECORD (continued) Page 8 Percentage of Time (see Schedule B) (a) (b) (c) (d) (e) Application of TheoryProcess/SystemsManagementCommunications Societal Implications Name, Title and Address of people most familiar with your relevant experience. 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