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Basic Information
Name
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Your answer
Street Address
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Your answer
City
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Your answer
Province / State
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Your answer
Postal Code / ZIP
*
Your answer
Phone Number
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Your answer
Email
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Your answer
What position are you applying for?
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The best way to contact me is:
Telephone
Email
Type of employment I seek:
Full Time
Part Time
Seasonal
Have you been employed by us before?
*
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Employment History
Name of Company #1
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Your answer
Street Address
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Your answer
City
*
Your answer
Province / State
*
Your answer
Postal Code / ZIP
*
Your answer
Phone
*
Your answer
Employed From
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DD
/
MM
/
YYYY
Employed To
*
DD
/
MM
/
YYYY
Job Held (Title)
*
Your answer
Rate of Pay
Your answer
Job Duties
Your answer
Supervisor's Name
Your answer
Supervisor's Phone Number
Your answer
Reason for Leaving
Your answer
Can we contact this employer?
*
Yes
No
Name of Company #2
Your answer
Street Address
Your answer
City
Your answer
Province / State
Your answer
Postal Code / ZIP
Your answer
Phone
Your answer
Employed From
DD
/
MM
/
YYYY
Employed To
DD
/
MM
/
YYYY
Job Held (Title)
Your answer
Rate of Pay
Your answer
Job Duties
Your answer
Supervisor's Name
Your answer
Supervisor's Phone Number
Your answer
Reason for Leaving
Your answer
Can we contact this employer?
Yes
No
Clear selection
Name of Company #3
Your answer
Street Address
Your answer
City
Your answer
Province / State
Your answer
Postal Code / ZIP
Your answer
Phone
Your answer
Employed From
DD
/
MM
/
YYYY
Employed To
DD
/
MM
/
YYYY
Job Held (Title)
Your answer
Rate of Pay
Your answer
Job Duties
Your answer
Supervisor's Name
Your answer
Supervisor's Phone Number
Your answer
Reason for Leaving
Your answer
Can we contact this employer?
Yes
No
Clear selection
Driving History
Driving Primarily:
Highway
Local
Other
Goods/Products Hauled:
Petroleum
Liquid Bulk
Dry Bulk
Freight
Other
Type of Trailer's Pulled:
Tandem
Tridem
Tank
Hopper
Convertibles
End Dump
Pneumatics
Super B
Type of Transmission:
Automatic
18 Speed
15 Speed
9 Speed
Other
Other Information
Where did you hear about us?
Your answer
Please check all that apply:
*
I am a Canadian Citizen
I am legally entitled to work in Canada
None of the Above
Required
Has any license, permit or privilege to operate a motor vehicle ever been suspended or revoked?
Yes
No
Clear selection
Do you have any infractions on your current abstract?
Yes
No
Clear selection
Are you able to perform all the requirements of the job?
Yes
No
Clear selection
Applicant Certification and Agreement
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal.
*
Yes
No
I authorize Border City Concrete / Crushers Sand & Gravel to verify the information provided in this application including reference verification with previous employers.
*
Yes
No
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