Fillable W5 Transport Ltd. Application For Employment

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W5 Transport Ltd. Application For Employment

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W5 Transport Ltd.
Application For Employment
Please Read Carefully and Print
Date: ___________________
Section 1 questions need to be completed by all applicants
Section 1
First Name: _________________
Middle Name: _________________
Last Name: _________________
Address: ________________________________________________________________
Street City Prov Postal Code
Phone Number: _____________________
Cell Number: _____________
Social Insurance Number:______________
Position Applying For: _________________
Date Available For Work: ______________
Are you legally eligible to work in Canada? Yes ____ No ____
Are you prepared to travel or be transferred if required to fulfill the duties of the
position for which you are applying? Yes_____ No _____
Contact Person in case of emergency:
Name: _________________________
Relationship: ____________________
Phone (work):____________________
Phone (home):____________________
Employment Record For The Past 10 Years (Last company first in order)
Name & Address of Company
________________________________________________________________________
Phone Number: __________________
Job Title: ___________________________
From:_____________ To: _____________
Reason for leaving:
___________________________________
___________________________________
Name & Address of Company
________________________________________________________________________
Phone Number: __________________
Job Title: ___________________________
From:_____________ To: _____________
Reason for leaving:
___________________________________
___________________________________
Name & Address of Company
________________________________________________________________________
Phone Number: __________________
Job Title: ___________________________
From:_____________ To: _____________
Reason for leaving:
___________________________________
___________________________________
Name & Address of Company
________________________________________________________________________
Phone Number: __________________
Job Title: ___________________________
From:_____________ To: _____________
Reason for leaving:
___________________________________
___________________________________
Employment History Continued…
Name & Address of Company
________________________________________________________________________
Phone Number: __________________
Job Title: ___________________________
From:_____________ To: _____________
Reason for leaving:
___________________________________
___________________________________
Name & Address of Company
________________________________________________________________________
Phone Number: __________________
Job Title: ___________________________
From:_____________ To: _____________
Reason for leaving:
___________________________________
___________________________________
Name & Address of Company
________________________________________________________________________
Phone Number: __________________
Job Title: ___________________________
From:_____________ To: _____________
Reason for leaving:
___________________________________
___________________________________
Name & Address of Company
________________________________________________________________________
Phone Number: __________________
Job Title: ___________________________
From:_____________ To: _____________
Reason for leaving:
___________________________________
___________________________________
Length of time worked at type of job applying for: ____________________________
Do you have any objection to the company checking with your former employer(s)
Yes ____ No ____
During the last 5 years, have you had to report to Workers’ Compensation Board with
a problem or injury which would affect your ability to perform the job for which you
are applying? Yes ____ No ____
If yes, please indicate the nature of your injury
________________________________________________________________________
________________________________________________________________________
Personal References
________________________________________________________________________
Name Occupation Address Phone
________________________________________________________________________
Name Occupation Address Phone
________________________________________________________________________
Name Occupation Address Phone
________________________________________________________________________
Name Occupation Address Phone
What are your employment goals? Are there talents or skills you would like to
develop for future career opportunities?
________________________________________________________________________
________________________________________________________________________
Section 2
Section 2 questions must be filled out for those applying for driving.
**Please make sure you also fill out and return the Abstract Consent Form along with this form**
www.w5transport.com/AbstractConsent.pdf
To the extent that it would affect your ability to perform the job applied for, are you
restricted at all to the use of:
If yes, please explain
Eyes
____ No
____ Yes
______________________________________________
Arms
____ No
____ Yes
______________________________________________
Hands
____ No
____ Yes
______________________________________________
Legs
____ No
____ Yes
______________________________________________
Feet
____ No
____ Yes
______________________________________________
Back
____ No
____ Yes
______________________________________________
Do you have any physical handicaps which would affect your ability to do the job
applied for?
____ No
____ Yes
______________________________________________
Have you received any Safe Driver Awards or other driving commendations? If yes,
describe
________________________________________________________________________
DRIVERS DISCLOSURE OF LICENSE
I ___________________________ hereby disclose the only jurisdiction in which I am
licensed, the class held, whether or not the license is suspended and the name in which
the license is issued.
Driver’s License Number:_________________
Expiry Date: __________
Prov/State: ____
Class: ______ Suspended? ____No ____ Yes
Drivers Signature: ___________________________
Date: _________________
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List each motor vehicle accident you have been involved in during the past 5 years and
its type. (rear-end, side-swipe, etc). Show how each was classed as Preventable or
non-preventable.
Date
Location
Type of Accident
Preventable/Non-Preventable
Driving Experience
Years
Miles/KMs
Straight truck
Tractor Trailer
Refrigerated
Extended length
Mountain
Winter Road
U.S.A.
Section 3
Section 3 questions only need to filled out for those people applying for clerical or
management positions.
EDUCATION
Type
Institution
# Year
Completed
Type of Course
Did you
graduate?
High School
College
Vocational
University
Other
PERS0NAL PROTECTIVE EQU1PMENT (PPE): We are referring to: to hard hats, hearing
protection, safety glasses, reflective clothing and safety footwear.
HARD HAT: A lateral protection hard hat which is CSN/ANSI. Preferably navy blue (other
colors are acceptable), peak to the front, in all areas of the Mill site including all outside
areas that are within the Mill boundaries. They should be worn in any area there is a
danger of something falling from above on your head.
You must maintain your hard hat in its original condition. You may place decals
on your hard hat, providing they are not used to cover flaws such as holes or
cracks.
Note: Aluminum hard hats are not permitted everywhere be careful it is
acceptable everywhere you load.
SAFETY GLASSES: CSA/ANSI (Z94-3) approved safety glasses with clear plastic lenses and
CSA/ANSI approved side shields will be worn on site including all outside areas that are
within the ill boundaries. Contact lenses may be used, but only in conjunction with the
approved safety glasses.
SAFETY FOOTWEAR: CSA approved Class 1 outdoor footwear (with green triangle) which
must be above the ankle and steel toed. Safety footwear must be worn by all personnel
in the mill and its boundaries. Safety footwear must be inspected regularly to ensure
they are free of holes, tears, and other damage. Damaged footwear must be replaced.
HEARING PROTECTION: Class “A” hearing protection devices must be worn (to reduce
passage of ambient noise into the auditory system) were personnel are exposed to
noise levels posted at or above 85dba. Hearing protection must be worn in all process
areas during operating hours and maintenance (shutdown) day.
EAR PLUGS: Hearing protectors inserted into the external ear canal
EAR CUPS: Ear covering designed to reduce the effects of excessive noise and
designed to fit over the entire hearing organ.
CLOTHING: High visibility clothing such as vest, jacket, or coveralls with reflective strips
on the front and back. Color of reflective stripes is not a factor. Shorts or long-sleeved
shirts and long pants are required. Muscle shirts and shorts is not acceptable wear.
FALL PROTECTION EQUIPMENT: is to be used to prevent people from falling, when
working unprotected, more than 6 feet above the floor.
__________________________________________
I have read and understand the information above
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W5 Transport Ltd. Application For Employment

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Completed 16 July 2021

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