Employment Application

Name

Address

City/Province

Postal Code

Home Phone

Important S.I.N.

Emergency contact/phone

Position applying for

Number of years experience driving a semi unit

Highest level of education completed

Where?

Do you require glasses?
 Yes No

Do you require a hearing aid?
 Yes No

Other medical devices/requirements?

Are you legally permitted to work in Canada?
 Yes No

Are you legally permitted to work in the US?
 Yes No

Do you have a Criminal Record?
 Yes No

Prior Employment History

Employer #1

Name

Address

City/Province

Supervisor's Name / Phone

Dates of Employment:

From To:

Duties

Reason(s) for leaving

Employer #2

Name

Address

City/Province

Supervisor's Name / Phone

Dates of Employment:

From: To:

Duties

Reason(s) for leaving

Employer #3

Name

Address

City/Province

Supervisor's Name / Phone

Dates of Employment:

From: To:

Duties

Reason(s) for leaving

References

Name/Phone Number #1

Name/Phone Number #2

Name/Phone Number #3

Verification

I hereby certify that the facts set forth in the above application are true and complete to the best of my knowledge. I understand that if employed, any and all falsified statements on this application shall be sufficient cause for my immediate dismissal.

Name

Date