Taylor Automotive Group Employee Warning Notice

Taylor Automotive Solutions – New Employee Application Form

All Companies within Taylor Automotive Solutions are equal opportunity employers. It is our policy to comply with Human Rights Codes prohibiting discrimination because of race,ancestry, place of origin, colour, national or ethnic origin, citizenship, religion, sex, sexual orientation, age, marital or family status, handicap disability or language. *

DATA

Last Name

First Name

Middle

Date of Application

Street Address

Home Phone

City

Prov

Postal

Other Phone

GENERAL

Position Being Applied for:

Salary / Earnings Expected

Date Available to Begin

Are you more than 18 and less than 65 years?

Are you legally eligible to work in Canada?

Are you bondable?

Yes

How did you learn of this position?

Are you currently Employed?

Can we contact your Employer?

Yes

EDUCATION

High School

Undergraduate

Graduate / Technical

Highest Grade or Level Completed

Type of Certificate or Diploma

Course of Study

Awards or Honours Received

SKILLS

Language Fluency

English

French

Other

FLEXIBILITY

Are you prepared to transfer between locations

Locally

Provincially

Within the Maritimes

Describe any of your work-related skills, experience, or training that relate to the position being applied for

List job related professional or technical organizations to which you belong.

Exclude those which may disclose characteristics protected by Human Rights Legislation as listed above.*

EMPLOYMENT HISTORY

Please give accurate, complete full time and part time employment records. Start with your present or most recent employer.

Company Name

Telephone Number

Address

Employed: (mo / yr )

From

Name and Title of Supervisor

Salary / Earnings

State job title and describe your responsibilities

Reason for Leaving

Company Name

Telephone Number

Address

Employed: (mo / yr )

From

Name and Title of Supervisor

Salary / Earnings

State job title and describe your responsibilities

Reason for Leaving

Company Name

Telephone Number

Address

Employed: (mo / yr )

From

Name and Title of Supervisor

Salary / Earnings

State job title and describe your responsibilities

Reason for Leaving

SIGNATURE

I hereby declare that the foregoing information is true and complete to the best of my knowledge. I understand that a false statement may disqualify me from employment, or cause my dismissal.

Signature:

Date:

TAS – DIS_Package _ Package 110

Service Order Form

E-mail: ll Free Fax: 1-866-323-3097Fax: 604-323-3097

1. Client Contact Information:

Company:▼Location:▼Date:▼

Taylor Automotive Solutions//

Hiring Manager:▼Phone Number:▼Email Results to:▼

2. Candidate Contact Information:

E-mail Address:▼Phone Number:▼

3. Service Menu - please services requested

BackCheck Package One

(Name Based Canadian Criminal Record Check & Credit Bureau Inquiry w/Identity Cross-Check)

4. Taylor Automotive Solutions representative please complete the following:

*ID Check is MANDATORY for a Name Based Criminal Record Check*

Two (2) pieces of legible identification are required:

1. The first of which must be government-issued and include the applicant’s name, date of birth, signature and photo
(e.g. Driver’s License, Passport, Citizenship Card, Permanent Resident Card, Certificate of Indian Status).

2. The second should be government-issued, however at minimum it must include the full name of the candidate.
~ Please send legible copies of the identification to BackCheck along with this cover and consent form. ~

Candidate Name:▼Position Applied For:▼

ID Verification One (1):

ID Verification Two (2):

Type:▼ Identification Number:▼

Ihave examined the identification of

Print Name of RepresentativePrint Name of Candidate

and I am satisfied that the candidate and person depicted in the photo identification are one and the same.

Signature of Rep. Confirming ID Check: X

Please E-mail or Fax the corresponding BackCheck consent forms along with supporting documents:
Copy of Candidate’s ID

E-mail:

Please ensure printing is 100% legibleToll Free Fax: 1-866-323-3097

6/1/12BM This fax is confidential. If you have received this fax in error, please call 1-877-308-4663 immediately.#100

Fax: 604-323-3097

Consent for Disclosure of Personal Information

Name Based Canadian Criminal Record Check & Credit Bureau Inquiry w/Identity Cross-Check

To ensure accuracy, you must PRINT in clear CAPITAL letters and complete this form in its entirety.

PLEASE NOTE: The following information and photocopies of identification are for identification purposes only, allowing BackCheck to accurately proceed with the assembly of a name based criminal record check for employment purposes. BackCheck will hold all personal information confidential.

Given Name(s):▼Middle Name(s):▼Gender:▼ Check One

Male Female

Surname:▼Maiden name:▼

Aliases, nicknames and any other names:▼

Place of Birth:▼Date of Birth:▼

CityProvinceCountryyyyymmdd

Current Address:▼From:▼To:▼

////

Unit NumberStreet NumberStreet Nameyyyymmddyyyymmdd

Current Address Continued:▼

CityProvinceCountryPostal Code

Previous Address - if less than 5 years ago:▼From:▼To:▼

////

Unit NumberStreet NumberStreet Nameyyyymmddyyyymmdd

Previous Address - Continued:▼

CityProvinceCountryPostal Code

Telephone Number:▼Alternative Telephone Number:▼Position Applied For:▼

I certify that the information in this Disclosure for Personal Information is true and correct to the best of my ability.

Have you been convicted of a criminal offence for which a pardon has not been granted?YesNo

If you have answered Yes to the question above, please provide details on those criminal convictions (attach additional pages if required):

OffenceDate (yyyy/mm/dd)LocationPenalty

Disclaimer: The existence of a conviction will not preclude you from consideration for employment with Taylor Automotive Solutions. Details of the
offence are requested to enable Taylor Automotive Solutions to determine whether the offence is related to your employment or intended
employment.

I have applied to Taylor Automotive Solutions for employment. Part of the screening process includes a search of the National Criminal Records repository, accessed through the Canadian Police Information Centre (CPIC) database, maintained by the RCMP, using the name(s) and date of birth provided above. BackCheck conducts these investigations on behalf of Taylor Automotive Solutions.

I hereby consent and authorize a Canadian Police Department to search for and disclose on my behalf to BackCheck who is requesting a name based Canadian criminal record check on behalf of Taylor Automotive Solutions the fact that records may exist on me and are registered on the CPIC database. I acknowledge that these records include information relating to criminal convictions under the Criminal Code andother Federal Statutes (Canada) for which a pardon has not been granted.

I authorize BackCheck to release all information obtained to Taylor Automotive Solutions and hold harmless BackCheck, its police partners and the RCMP upon the release of this information or its findings to Taylor Automotive Solutions.I understand that failing to provide accurate information or omission of facts herein may disqualify me from consideration for employment with Taylor Automotive Solutions.
Furthermore, if there is a discrepancy with the information provided by myself on this form and that disclosed by a Canadian Police Department during this investigation of my criminal records history, I understand that I have the option to provide my fingerprints to resolve any discrepancy or dispute.
This request is made in compliance with any applicable federal, provincial or municipal public sector privacy legislation which allows a public body or municipality to disclose my personal information to me or my agent upon my request. Also the ‘Supplemental Information Sheet Regarding Name Based Criminal Record Checks’ has been made available to me.

Candidate Signature:

Authorizing Name Based Criminal Record Check

Hiring Manager’s Signature:

Witnessing the candidate’s signature

Date: (yyyy/mm/dd)▼

X//

Date: (yyyy/mm/dd)▼

X//

In connection with my application for employment with Taylor Automotive Solutions, I understand that the background check process includes a Canadian Credit Bureau Inquiry with Identity Cross-Check, with retrieval of information from a major Canadian credit bureau.
I hereby consent to a Canadian Credit Bureau Inquiry with Identity Cross-Check by BackCheck, on behalf of Taylor Automotive Solutions, which will include information about me, including any previous bankruptcies, legal proceedings, collection actions, negative banking items and other information reported by my creditors, and I hereby authorize any public or private institution to provide and release to BackCheck information related to my credit record. I authorize BackCheck to release all personal information obtained during the above Canadian Credit Bureau Inquiry with Identity CrossCheck to Taylor Automotive Solutions.

Candidate Signature:

Authorizing Credit Bureau Inquiry with Identity

Date: (yyyy/mm/dd)▼

X//

TAS – Application - Form 120