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Date: / /
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| Name |
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First |
Middle |
last |
| Phone home |
-
-
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-
-
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Home |
Cell |
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| Current address* |
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Street |
City |
Province - Postal code |
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| *If at the above residence less than three years, list below all residence for the past three years. |
| Past residence (optional) |
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Street |
City |
Province - Postal code |
| Past residence (optional) |
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Street |
City |
Province - Postal code |
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| Position applying for |
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Temporary
Part-time
Full time
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| Who refered you? |
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Rate of pay expected? |
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| Have you worked for this company before? |
Yes
No
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| If so... |
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| Dates |
From / |
To / |
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month /year |
month /year |
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| Where? |
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Rate of pay |
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| Position |
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| Reasons of leaving |
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| Names of any relative employed by this company |
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| Are you currently employed? |
Yes
No
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If not, how long since leaving last employment? |
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| Highest grade completed |
1
2
3
4
5
6
7
8
9
10
11
12
College
1
2
3
4
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| Last school attended |
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Name |
Address |
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| Have you ever been bonded? |
Yes
No
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Name of bonding company |
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| (Answer only if a job requirement) |
Have you ever been convicted of a felony?
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Yes
No
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If yes, please explain fully
(Conviction crime is not an automatic bar to employment - all circumstances will be considered.) |
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| Have you worked for this company under another name? |
Yes
No
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If so, under what name? |
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Answer the questions in this section only if applying for driver position
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| Date of birth |
/ / |
Social Insurance Number |
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month / day / year |
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| Name |
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Phone |
- - |
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| Driver's license number |
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Class |
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| Expiration date |
/ / |
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month / day / year |
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Any restriction(s)?
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Yes
No
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| If yes, state which one(s) |
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| Date of your last demerit point(s) abstract |
/ / |
Points lost |
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month / day / year |
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| Do you have a permitted to haul hazardous materials? |
Yes
No
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| Expiration date |
/ / |
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month / day / year |
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| Do you have access to an automobile if the position applied for requires you to travel?
Yes
No
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| Availability date |
/ / |
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month / day / year |
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| Are you available to work during the |
Day
Evening
Night
Weekend
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| Type of transportation operations |
Local
Long distance
Other provinces
USA
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| If you are applying for a long distance driver position, how many years experience on the following |
| Straight body |
yrs |
Train (double) |
yrs |
| Van |
yrs |
A-Train |
yrs |
| Flat bed |
yrs |
B-Train |
yrs |
| Refrigerated |
yrs |
Container |
yrs |
| Liquid tank |
yrs |
Concrete mixer |
yrs |
| Dry bulk tank |
yrs |
Dump truck |
yrs |
| Liquefied gas tank |
yrs |
Shunter |
yrs |
| Wide load |
yrs |
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Answer the questions in this section only if applying for driver position
Licenses (Driver license held in past 3 years must be shown)
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| A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? |
Yes
No
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| B.Has any license, permit or privilege ever been suspended or revoked? |
Yes
No
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| C.Have you ever been disqualified for violations of the Federal Motor Carrier safety regulation? |
Yes
No
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| If you answered "yes" to A,B,C, give details. |
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