Staff InformationName* First Last Student Number*Email (Carleton CMAIL only)* Program, Year*Example: Aerospace, 2 (year completed, not year standing in the Fall) T-shirt Size*AS = Adult Small etc.ASAMALAXLAXXLCell Phone Number*Allergies/Dietary Restrictions/Medical Conditions*Please include all dietary restrictions and allergies. If none, please say "N/A or none"Address*Your current address (would be used to ship materials and supplies to you if needed) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Certifications & DocumentsDo you have a Police Record Check (PRC)?*New staff: We require a Police Record Check for the Vulnerable Sector (level 3 with Ottawa Police or equivalent) validated on or after August 1 2021. If you do not have one to submit, you will ned to request a new one which we will reimburse you for. Returning Staff: if you submitted your PRC in May 2021 or later, you do not need to submit a new one. If you did not submit one in May 2021 or later, you will need to submit a new one which we will reimburse you for. Returning staff not submitting a new one, please select "Yes, I have sent it over email already" *If you selected "No, I have not requested one yet" please request one now.Yes, I have sent it over email alreadyYes, I will attach it hereNo, I have requested one but not received it yetNo, I have not requested one yetDid you request a PRC for this job and will be submitting for reimbursement?*A reminder, we will need the original copy if submitting for reimbursement.YesNoPolice Record Check*What Date did you request your Police Record Check* Date Format: MM slash DD slash YYYY Drivers License*Full G (or equivalent)G2 (or equivalent)Do not have a Driver's LicenseOther CommitmentsAre you planning to take any summer courses?* Early (May-June) Late (July-August) Full (May-August) None How many courses are you planning on taking?*Do you have any other commitments outside of this position?*Example: another part-time jobYesNoPlease let us know your other commitments and if it would affect your work hours in any way**including weekly evening commitments (as in July-August we will meet once a week for a staff meeting after campEmergency Contact 1:Name* First Last Relationship to you*Cell Phone Number*Home Phone NumberWork Phone Number Share: Twitter, Facebook Short URL: https://carleton.ca/vv/?p=2379