Global Pacific Xpress Inc

GLOBAL PACIFIC XPRESS INC.

9685-160A St. Surrey, BC V4N 3K8

TEL: 778-898-4794

TEL: 778-898-0170

FAX: 604-582-0323

APPLICATION FOR EMPLOYEMENT

Please answer all questions. If the answer to any question is “No” or “None” do not leave the item blank, but write “No” or “None”. Fill this application in capital letters and neatly, this is important.

DATE OF APPLICATION: ______POSITION APPLIED FOR ______

O/O OR DRIVER

NAME: ______

LAST FIRST MIDDLE

ADDRESS: ______

CITY PROVINCE POSTAL CODE

PAST THREE YEAR ADDRESS:

______FROM______TO______

ADDRESS

______FROM______TO______

ADDRESS

______FROM______TO______

ADDRESS

HOME PHONE: ______CELL: ______

DATE OF BIRTH: ______SIN# ______

EMERGANCY CONTACT NAME: ______RELATIONSHIP______

HOME PHONE: ______CELL: ______

APPLICATION FOR EMPLOYEMENT PAGE 1OF6

DO YOU HAVE THE LEGAL RIGHT TO WORK IN CANADA? ______

YES OR NO

HAVE YOU WORKED FOR THIS COMPANY BEFORE? ______WHEN?______

YES / NOYEAR

ARE YOU NOW EMPLOYED? ______RATE TO BE EXPECTED? ______

YES / NO

HOW DID YOU FIND OUT ABOUT OUR COMPANY? ______

EDUCATION HISTORY:-

PLEASE CIRCLE THE HIGHEST GRADE COMPLETED:

SCHOOL: 1 2 3 4 5 6 7 8 9 10 11 12

COLLEGE: 1 2 3 4 POST- GRADUATE: 1 2 3 4

EMPLOYEMENT HISTORY: (PRESENT TO PAST EMPLOYERS)

GIVE A COMPLETE RECORD OF ALL EMPLOYEMENT FOR THE PAST THREE YEARS, INCLUDEING ANY UNEMPLOYEMENT OR SELF EMPLOYMENT, ALL COMMERCIAL DRIVING EXPERIENCE FOR THE PAST TEN YEARS.

EMPLOYER NAME DATE

NAME: ______FROM______TO______

MM / YY MM / YY

ADDRESS: ______

CITY PROV. POSTAL CODE

PHONE: ______CONTACT PERSON: ______POSITION HELD______

O/O , DRIVER

REASON FOR LEAVING: ______SALARY / WAGES ______

EMPLOYER NAME DATE

NAME: ______FROM______TO______

MM / YY MM / YY

ADDRESS: ______

CITY PROV. POSTAL CODE

PHONE: ______CONTACT PERSON: ______POSITION HELD______

O/O , DRIVER

REASON FOR LEAVING: ______SALARY / WAGES ______

APPLICATION FOR EMPLOYEMENT PAGE 2 OF 6

EMPLOYER NAME DATE

NAME: ______FROM______TO______

MM / YY MM / YY

ADDRESS: ______

CITY PROV. POSTAL CODE

PHONE: ______CONTACT PERSON: ______POSITION HELD______

O/O , DRIVER

REASON FOR LEAVING: ______SALARY / WAGES ______

EMPLOYER NAME DATE

NAME: ______FROM______TO______

MM / YY MM / YY

ADDRESS: ______

CITY PROV. POSTAL CODE

PHONE : ______CONTACT PERSON:______POSITION HELD______

O/O , DRIVER

REASON FOR LEAVING: ______SALARY / WAGES ______

EMPLOYER NAME DATE

NAME : ______FROM______TO______

MM / YY MM / YY

ADDRESS: ______

CITY PROV. POSTAL CODE

PHONE : ______CONTACT PERSON:______POSITION HELD______

O/O , DRIVER

REASON FOR LEAVING: ______SALARY / WAGES ______

EMPLOYER NAME DATE

NAME : ______FROM______TO______

MM / YY MM / YY

ADDRESS: ______

CITY PROV. POSTAL CODE

PHONE : ______CONTACT PERSON:______POSITION HELD______

O/O , DRIVER

REASON FOR LEAVING: ______SALARY / WAGES ______

APPLICATION FOR EMPLOYEMENT PAGE 3 OF 6

QUALIFICATION AND DRIVING EXPERIENCE:-

DRIVER LICENSE: -

STATE / PROVINCE: ______LICENSE #______TYPE______EXPIRATION DATE ______

1. HAVE YOU EVER BEEN DENIED A LICENSE, PERMIT OR PRIVILEGE TO OPERATE MOTOR VEHICLE?______

YES / NO

2. HAS ANY LICENSE, PERMIT OR PRIVILEGE EVER BEEN SUSPENDED OR REVIKED? ______

YES / NO

3. HAVE YOU EVER TESTED POSITIVE OR REFUSED A DOT DRUG OR ALCOHOL PRE-EMPLOYMENT TEST WITHIN

THE PAST TWO YEARS FROM AN EMPLOYER WHO DID NOT HIRE YOU? ______

YES / NO

4. HAVE YOU EVER BEEN CONVICTED IN ANY CRIME? ______

YES / NO

IF THE ANSWER TO 1, 2, 3 OR 4 ARE YES, GIVE DETAILS: ______

______

ACCIDENT RECORD FOR PAST THREE YEARS:

DATE OF ACCIDENT ------NATURE OF ACCIDEND------FATALITIES ------INJURIES------

______

TRAFFIC CONVICTION AND FOFEITURES FOR PAST THREE YEARS:-

DATE LOCATION CHARGES PENALTY

______

DRIVING EXPERIENCE:

STRAIGHT TRUCK ______FROM ______TO ______MILES DRIVEN ______

(VAN, FLAT, TANK, CHASSIS, ETC.) YEAR YEAR KM / MI

TRUCK & SEMI TRAILER ______FROM ______TO ______MILES DRIVEN ______

TRUCK-TWO TARILER ______FROM ______TO ______MILES DRIVEN ______

TRUCK-CONTAINER ______FROM ______TO ______MILES DRIVEN ______

OTHER ______FROM ______TO ______MILES DRIVEN ______

LISTSTATE AND PROVINCEC OPERATED IN FOR LAST FIVE YEARS: ______

LIST SPECIAL COURSES / TRAINING THAT WILL HELP YOU AS A DRIVER: -______

LIST ANY SAFE DRIVING AWARD YOU HOLD AND FROM WHOM? ______

APPLICATION FOR EMPLOYEMENT PAGE 4 OF 6

TO BE READ AND SIGNED BY APPLICANT:-

It is agreed and understood that any misrepresentation given on this application for qualification shall be considered an act of dishonesty.
I agree to furnish such additional information and complete such examination as may require completing my employment file.
It is agreed and understood that this application for qualification on no way obligated the motor carrier to employ me.
It is agreed and understood that if qualified to operate motor carrier equipment, I may be on a probationary period for 90 Days, during which I may be disqualified without recourse.
I understand and agree that my Pay is included Vacation Pay and Statutory Holiday Pay.
I give the Global Pacific Xpress Inc. and its agents or representatives the right to investigate all references and to secure additional information about my employment background. I hereby release from all liability for damages the motor carrier and its agents or representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.
This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

______

APPLICANT’S SIGNATURE DATE

FOR OFFICE USE ONLY:-

APPLICATION FOR EMPLOYEMENT PAGE 5 OF 6

DRIVER MUST COMPLETE THE FOLLOWING PART AND SIGN:

I, ______have read the above and understand that my previous employer (s) will be contacted regarding my work and character history.

Signature: ______Date: ______

REFERENCE CHECK: (OFFICE USE ONLY) DO NOT FILL OUT.

DATE: ______SUBMITED BY ______TIME: ______

APPLICANT: ______POSITION APPLIED FOR: ______

COMPANY NAME: ______

CITY PHONE #

DATE OF EMPLOYMENT: ______RELATIONSHIP TO EMPLOYMENT: ______

DUTIES: ______

EVALUATION: -

ANY VEHICLE ACCIDEND WHILE IN YOUR COMPANY? YES ______NO ______

IF YES, DESCRIBE: ______

REASON FOR LEAVING? : ______

WOULD YOU RE – EMPLOY? ______

ABILITY TO GET ALONG WITH OTHER: ______

ABILITY TO LEARN: ______

TO ACCEPT RESPONSIBILITY: ______

TO FOLLOW ISTRUCTION: ______

TO TAKE SUGGESTION/ CRITISIM: ______

ATTITUDE: ______

PUNCUTALITY: ______

ADDITIONAL COMMENTS: -______

RESULT: ______EXCELLENT ______GOOD ______FAIR ______POOR

Signature: ______Date: ______

APPLICATION FOR EMPLOYEMENT PAGE 6 OF 6