Recruitment Form

Date

Position Applied For*

Trailer Mechanic

Truck Mechanic (Diesel)

General Labour

Operations

Administration

Parts Personnel

Shift Preference

Full-time

Part-time

Days

Evenings

First Name*

Last Name*

Phone Number*

Email Address*

example@example.com

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Previous Address (if less than 3 years at current address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employment History

Please list employers in reverse order starting with the most recent; include complete mailing address/street number, city, province and postal code for each.

Previous Employer (1)*

Name of Previous Employer

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

May we contact this employer?*

Yes

Position Held*

From*

Date

To*

Date

Previous Employer (2)

Name of Previous Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

May we contact this employer?

Yes

Position Held

From

Date

Can you legally work in Canada?*

Yes

Are you currently employed?*

Yes

What is your legal status?

Canadian Citizen

TFW

Permanent Resident

Other

Have you worked for Ultimate Upfitting & Fab Inc. before?*

Yes

How did you learn of an opening with our company? Were you referred? If so, by whom?*

Expected Rate of Pay:

Education:

Education Level*

Highest Level of Education Completed*

Please provide course of study, including any honors received:

Please describe any specialized / apprenticeship training, skills or Certifications which you feel are applicable: If additional space is required, please attach separate sheet:

Driver Licenses:

Province*

License Number*

Type/Class*

Expiration Date*

Please indicate if you have other licenses

I certify that this application has been completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize Ultimate Upfitting & Fab Inc. to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information provided in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all the rules and regulations of the company.

Do you agree/disagree with the statement as presented above?*

I agree with the statement as presented above

I disagree with the statement as presented above

Applicant Signature

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