ELECTRONIC APPLICATION FOR EMPLOYMENT

Position applied for:                                                   * required fields

Semi (owner-operator)
3-ton Haul & Tow Semi (company driver)
1-ton Single Truck

* First Name * Last Name

* Street Address * City, Province, Postal Code

Previous Address (if under 2 yrs) City, Province, Postal Code

* Email Address * Phone Number

Birth Date (mm/dd/yyyy) Birth Country

Current License Class Issuing Province

Experience and Qualifications:

Previous License (if above under 2 yrs) Issuing Province, Expiry

Driving History (1-ton, 3-ton, semi, etc.)

Equipment Operated (deck, van, etc.)

Years of Experience

Single     Team

Single     Team

Traffic Violations (Province, Date)

Details (conviction, penalty)

Have you ever been denied a license,      or had your driving privileges revoked? (whether medical or legal reasons)
Yes (provide details)   No

This is a preliminary application.
A recruitment officer will review your
document, and respond shortly.

Thank you for your interest in Roadex

Do you have a criminal record, or any immigration restrictions that would   prevent you from crossing the border?
Yes (provide details)   No

We will require hardcopies of your:
- driver's abstract
- criminal records search
- medical, current to within 3 months
- employment references

How would you like us to contact you?

Phone
Mail (provide if different from above) E-Mail
Fax (provide below)

ELECTRONIC APPLICATION FOR EMPLOYMENT
Position applied for: required fields*
Semi (owner-operator) 3-ton Haul & Tow	Semi (company driver) 1-ton Single Truck
* First Name	* Last Name

* Street Address	* City, Province, Postal Code

Previous Address (if under 2 yrs)	City, Province, Postal Code

* Email Address	* Phone Number

Birth Date (mm/dd/yyyy)	Birth Country

Current License Class	Issuing Province

Experience and Qualifications:
Previous License (if above under 2 yrs)	Issuing Province, Expiry


Driving History (1-ton, 3-ton, semi, etc.)	Equipment Operated (deck, van, etc.)

Years of Experience
	Single Team

	Single Team
Traffic Violations (Province, Date)	Details (conviction, penalty)



Have you ever been denied a license, or had your driving privileges revoked? (whether medical or legal reasons) Yes (provide details) No This is a preliminary application. A recruitment officer will review your document, and respond shortly. Thank you for your interest in Roadex	Do you have a criminal record, or any immigration restrictions that would prevent you from crossing the border? Yes (provide details) No We will require hardcopies of your: - driver's abstract - criminal records search - medical, current to within 3 months - employment references
How would you like us to contact you?
Phone Mail (provide if different from above)	E-Mail Fax (provide below)