Employment

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* Subject:

* Position:

* Team Partner Name:

* Date:

Referred by:

Are you 22 or older?

Do you have a Driver's License?

Special License: AZ

* License Number:

* Province Issued:

Contact Information

We require basic information so we can contact you.

* Full Name::

* SIN:

* Phone Number :

* Mobile Number :

Fax Number:

* Email Address:

* Address:

* City:

* Province/State:

* Postal/Zip Code:

Must be accurate information to process your application accordingly.

* Have you ever had your Driver's License suspended or Revoked?:

If so, please explain:

* Have you ever been cited for driving under the influence of alcohol or drugs?:

If so, please explain:

* Have you ever been convicted of a criminal offense for which you have not received a pardon?:

If so, please explain:

* List any accidents regardless of fault in last three years? (Write NONE if you do not have any):

* Have you ever applied or been employed by Trans 99 Logistics?:

When:

Where:

* Additional Comments (Write NONE if you do not have any):

Employment History - Employer 1

* Name of Current or most Recent Employer:

* May we contact them?:

* Employer Address:

* Employer Phone Number:

* Reason for leaving:

* State/Provinces Operated in:

* Type Equipment Operated:

* Position Title:

* Rate of Pay:

* Employed (From - To):

Employment History - Employer 2

* Name of Current or most Recent Employer:

* May we contact them?:

* Employer Address:

* Employer Phone Number:

* Reason for leaving:

* State/Provinces Operated in:

* Type Equipment Operated:

* Position Title:

* Rate of Pay:

* Employed (From - To):

Employment History - Employer 1

* Name of Current or most Recent Employer:

* May we contact them?:

* Employer Address:

* Employer Phone Number:

* Reason for leaving:

* State/Provinces Operated in:

* Type Equipment Operated:

* Position Title:

* Rate of Pay:

* Employed (From - To):

I certify the above information to be true and correct. I authorize ekamffinc to conduct a complete background investigation, including past drug and alcohol employment testing results, in accordance with the governing legislation. I further authorize my previous employers to release any information requested by ekamffinc and hold them harmless of all liability from the release of said information.