David Brown United; Longhaul services throughout the Maritimes, Ontario, and Quebec

EMPLOYMENT APPLICATION

Date of this Application:
Position Applied For:	Local Driver Long Haul Driver
First Name :
Last Name:
Social Insurance #:
Current Address:
Province
Postal Code :
Day Phone :	() Ext.
Email:
Date of Birth:
Can you provide proof of age?:	YES NO
Have you worked for David Browns before:	YES NO If Yes, when
Reason for leaving:
Are you now employed?	YES NO
If not, how long since leaving last employment:
Who referred you?
Rate of pay expected:
This job requires hard physical labor. Is there any reason you might be unable to perform the functions of the job for which you have applied?	YES NO
If yes, please explain if you wish:

EMPLOYMENT HISTORY AND REFERENCES

Please indicate with a "Y" next to the employers if it is OK to contact. If for some reason you do not want us to contact the employer IE: you are currently employed there, please make an "X" by the employer.

1. Employer Name:		From: To:
Address:		Position:
City:		Wage:
Contact Person:		Reason for leaving:
Phone:		Fax:

2. Employer Name:		From: To:
Address:		Position:
City:		Wage:
Contact Person:		Reason for leaving:
Phone:		Fax:

3. Employer Name:		From: To:
Address:		Position:
City:		Wage:
Contact Person:		Reason for leaving:
Phone:		Fax:

PERSONAL REFERENCES
1. Reference Name:
Address:
City:
Phone:
2. Reference Name:
Address:
City:
Phone:

Accident Record: Please provide dates, nature of accident, fatalities and injuries in your statement.
Traffic Convictions & Violations: Please provide location, date, charge and penalty.
Last Grade Complete:	College (yrs):
Last School Attended	Name: City:

Experience and Qualification - Driver

Drivers License Master Number:
Province Issued:
Type/Class
Drivers License Expiration Date
A. Have you been denied a license, permit or privilege to operate a motor vehilce? YES NO B. Have any license, permit or privilege ever been suspended or revoked? YES NO C. Have you received a fine or ticket for another carrier that you believe might be satisfied, and still be outstanding against your license? YES NO If the answer is YES to A, B or C, please provide a statement giving details.
Class of Equipment	If you choose other, please specify:
Approx. # of Miles
Areas that you have operated the above equipment in:	Canada: List Provinces: