APPLICATION FOR EMPLOYMENT

1. Name:
2. Address:
Phone:
3. Position being applied for:
4. If your application is considered favourable, on what date will you be available for work?
 
5. Are you legally eligible for work in Canada?
  Yes No
6. Are you prepared to travel or be transferred if required to fulfil the duties of the position for which you are applying?
  Yes No
If no please explain:
 
7. EMPLOYMENT RECORD FOR THE PAST TEN YEARS (Last Company first in order)
Company
Address
Phone #
Length of service
From to
Reason for leaving
 
8. Length of time worked at type of job applied for:
 
9. Do you have any objection to the company checking with your former employer(s) about your work habits and employment record?
  Yes No
If no please explain:
 
10. During the past five years have you had to report to Workers' Compensation Board for assistance with a problem or injury which would affect your ability to perform the job for which you are applying?
  Yes No
 
11. Indicate the nature of the injury that you reported if the injury relates to the job applied for:
 
 
12. PERSONAL REFERENCES
Name
Occupation
Address
Phone Number
 
Questions 13 and 14 to be completed by those applying for driving and freight handling positions.
 
13. To the extent that it would affect your ability to perform the job applied for, are you restricted at all to the use of:
Eyes  Yes No
Arms  Yes No
Hands  Yes No
Legs  Yes No
Feet  Yes No
Back  Yes No
If yes please explain:
 
14. Do you have any physical handicaps which would affect your ability to do the job applied for?
  Yes No  Explain
 
Questions 15 to 17 to be completed for those applying for driving positions.
 
15. Drivers License Number:
Province:
Class:
Condition Codes/ Endorsements:
 
16. Have you received any Safe Driver Awards or other driving commendations?
If yes describe:
 
17. List each motor vehicle accident you have been involved in during the past 5 years and its type (rear end, sideswipe, etc.) Show how each was classed as preventable or non-preventable.
Date
Location
Type of Accident
Preventable?
Yes No
Yes No
Yes No
Yes No
 
The following questions are to be completed by all applicants.
 
18. Education
Type
Institution
Dates
City
Type of Course
Elementary
High School
College
Post-Grad
Other
 
19. What are your employment goals, are there any talents or skills you would like to develop for the future career opportunities?
 

I hereby declare that foregoing information is true and complete to the best of my knowledge. I understand that a false statement may disqualify me from employment or cause my dismissal. I understand also that if this application is for a driving position I may be required to take a company administered road test from time to time at the company's request. Failure to satisfactorily complete this road test may disqualify me from employment or cause my dismissal. If this application is for a driving position, I hereby give my consent to the company to obtain a copy of my driving record from the appropriate government authority and should I be hired by the company it may undertake to obtain copies of my driving record as and when they may so require without further consent.

I hereby acknowledge that any job offer may be conditional upon the passing of a medical examination requested by the company and as administered by a company appointed doctor. I understand that failure to meet the company's standards pertaining to medical fitness is sufficient cause to disqualify me from employment or cause my dismissal.