Employment Form
 

1/7 DESIRED POSITION AND AVAILABILITY

Desired position :
Truck driver 
Day laborer        
Lift truck operator 
Owner operator
Office position
Date available :

day month year
Are you available :
Day 
Evenings 
Nights
Weekends
If you are applying for a job as a driver :
What type of transport :
Local
Long distance
USA
Other provinces
 
 
.

2/7 PERSONAL INFORMATION

Last name :
First name :
Address :
City :
Postal/Zip Code :
S.I.N. :
Date of birth :  
Telephone - home :
() -
Telephone - 2 :
() -
 
Person to contact in case of emergency or accident on the job :
Name :
Telephone :
() -
 
Driver's license No : Class :
Expiry date :    
Do you have any restrictions ? yes no    
If yes, which ones :
       

3/7 EDUCATION

Last school year completed :
Location :
Last grade completed :
Specialty :
  Year :
Language(s) spoken      
 
English French
Speak
Read
Write
Others :
 
Have you received professional driver training ?
yes no    

If yes, where :

   

Hours of theoretical training :

Practical training :

Course date :

Diploma obtained :

 yes no
 
 

4/7 DRIVING (accidents and incidents)

Have you been involved in any accidents related to the use of a heavy vehicle during the last 5 years ?  yes no
 
If yes, indicate the date and the nature of such accident(s) :    
 
Name of employer at that time :
Description of accident(s) :
 
 
 
 

5/7 EXPERIENCE AND SKILLS (Day laborer and Lift truck operator)

You do not have to complete this section
Describe your merchandise handling experience :
 
What type of lift truck have you operated ?
   
If applicable, indicate any courses taken at that level :
 
 

6/7 PREVIOUS EMPLOYERS

Below please list the jobs you have held in the last 5 years, starting with the most recent job.

Employer :

Telephone :

 ( ) -
Address :

To :
Job title :

From :

Supervisor :

Pay at time of leaving :

Reason for leaving :

   
 

Employer :

Telephone :

 ( ) -
Address :

To :
Job title :

From :

Supervisor :

Pay at time of leaving :

Reason for leaving :

   
 

Employer :

Telephone :

 ( ) -
Address :

To :
Job title :

From :

Supervisor :

Pay at time of leaving :

Reason for leaving :

   
 

Employer :

Telephone :

 ( ) -
Address :

To :
Job title :

From :

Supervisor :

Pay at time of leaving :

Reason for leaving :

   
 
 
 

7/7 ACCEPTANCE

 
I hereby authorize the company and/or its representatives to request a copy of my file from the Commission de la Santé et de la Sécurité du travail du Québec.

I agree to supply additional information and/or documents to complete this form insofar as this is required for the purposes of this job application. I also agree to undergo a medical examination conducted by a physician chosen or designated by the company if I am offered a job subject to that condition.

I understand that if I make a false statement or fail to provide information required on this form or during the hiring process, I may be dismissed as of the discovery of such false statement or omission, in compliance with the bonding requirements of the company's internal work agreements.

I hereby authorize the company and/or its representatives to enquire about my judicial record with reference to any incidents that may have a bearing on the desired position (for example, but without limiting the generality of what precedes, impaired driving, etc.), to verify my service record and make sure that all the statements I make on this form or during the hiring process are accurate and complete.

I hereby authorize the company and/or its representatives to verify my driving record for the purposes of this job application by requesting information from the Société de l'assurance automobile du Québec (S.A.A.Q.) whom I authorize to disclose such information if need be. I also authorize the company and/or its representatives to verify the validity of my driver's license for the purposes of this job application. I agree to give the company my driver's license number to enable the above?mentioned verification to be carried out should I be offered a job subject to such verification.

For the purposes of this job application, I also authorize the company and/or its representatives to contact my previous employers and/or any other companies or individuals who hold information about me in order to verify if all the statements I made on this form or during the hiring process are accurate and complete, even if such information is personal and confidential.

Furthermore, should this be required for the position I am applying for and should my application be accepted, I authorize the company and/or its representatives to communicate the personal information it has about me to its customers, in compliance with Sections 13 and 14 of An Act Respecting the Protection of Personal Information in the Private Sector (hereinafter referred to as the "Act").

In order to obtain personal information about me, the company shall act as a representative for the purposes of Sections 6 to 30 of the Act. In addition, as provided for by Section 8 of the Act, the company shall inform me of the use it makes of all the information gathered about me. The authorizations contained on this form are valid only for the time required to assess my job application and, in the event that the company offers me a job and that I accept the job, for the term of my employment.

I am aware that if I am hired, I shall undergo a probation period during which my employment may be terminated at any time without my having any right of recourse.

Thank you for completing this employment form. We subscribe to the principle of equality of employment. Any references to male persons on this form also include female persons.

 

Through what source of information did you hear about us?

Newspaper :

Which one: On what date:
Other sources :
Signature :