Apply for Pre-Employment Package | Trucking Jobs in Winnipeg

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1 General Info

2 Application

3 FREIGHT /HANDLING

4 DRIVING POSITIONS

5 DECLARATIONS

6 SCHEDULE A

7 SCHEDULE D

Application For Employment

Family Name

Given Name

Address

Phone

City

Province

Postal Code

S.I.N.

Position Applying For

Are You Legally Eligible For Employment In Canada?

YesNo

During The Past Five Years, Have You Had To Report To A Worker' Compensation Board For Assistance With An Injury Which Would Affect Your Ability To Perform The Jobs For Which You Are Applying?

Injuries?

YesNo

If Yesplease indicate the nature of the injury

0 /

Do You Have Any Objections To The Company Contacting Your Former Employer(s) Reference Your Work Habits And Employment Records?

YesNo

If Yesplease explain

0 /

If Your Application Is Considered Favorably, On Which Date Would You Be Available For Work?

Available Start Date

Personal References

Company	Phone	Dates	Address	Supervisor	Reason for Leaving
						×
						×

(2)

Employment HistoryStart with most recent

Name	Phone	Position	Address
				×
				×

(2)

TO BE COMPLETED BY THOSE APPLYING FOR A DRIVING POSITION (if this doesn't apply to you, please skip to next step):

Drivers License #

Class

Province

List Safe Driver Awards Or Other Driving Commendations Received:

0 /

List Other Licenses You May Hold:

State	License #	Class	Exp. Date
				×
				×

(2)

Driving Experience

List Provinces /States Operated in for the past 10 years:

0 /

Show Special Courses And Training That Will Help You As A Driver

0 /

Have you ever been involved in an accident?

YesNo

If Yes, Give details

0 /

Have You Ever Been Denied A License, Permit Or Privilege To Operate A Motor Vehicle?

YesNo

Has Any License, Permit Or Privilege Been Suspended Or Revoked?

YesNo

Have you ever been convicted of:

Speeding

YesNo

If Yes, Give Dates

Dangerous Driving

YesNo

If Yes, Give Dates

Impaired Driving

YesNo

If Yes, Give Dates

TO BE COMPLETED BY ALL APPLICANTS :

DECLARATIONS:

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. I understand also that if this application is for a driving position I may be required to take a company administered road test from time to time at the company's request. Failure to satisfactorily complete this road test may disqualify me from employment or cause my dismissal.

By clicking you are agreeing to the above

I Agree

I hereby acknowledge that any job offer may be conditional upon the passing of a medical examination and/or test for alcohol or drug dependency if requested by the company and as administrated by a company appointed doctor. I understand that failure to meet the company's standards at this time, or at any time in the future, pertaining to medical fitness or alcohol or drug dependency, is sufficient cause to disqualify me from employment or cause my dismissal.

By clicking you are agreeing to the above

I Agree

If this is an application for a driving position, I agree to provide a current abstract of my driving record from the motor vehicle department, should I be hired, I hereby give my consent to the company to request a copy of my driving records as and when requested.

By clicking you are agreeing to the above

I Agree

Request for Information from Previous Employer

I [field5] hereby authorize the following to release information to Harris Transport (R.S. Harris Ltd), for the purposes of investigation as required by section 391.23 of the Federal motor carrier Safety Regulations. You are released from any and all liability which may result in furnishing such information.

Previous Employers

Company	Address	Phone #	Contact Name
				×
				×

(2)

SCHEDULE "A" - CONSENT FOR DRUG AND ALCOHOL TESTING

(TO BE EXECUTED BY ALL EMPLOYEES AND APPLICANTS WHO ARE OFFERED EMPLOYMENT)

1. I understand that as a condition of employment, or continued employment, with R.S. Harris Transport Ltd., I must be part of, and consent to, drug and alcohol testing which is required by the American Department of Transportation.

2. I confirm and acknowledge that I have been informed that drug and alcohol testing includes PreEmployment, Post Accident, Random, Return to Duty, Follow Up and Reasonable Suspicion tests as set out in Zero Tolerance Drug and Alcohol Policy, (the "Policy") of which a true copy has been provided to me.

3. I confirm and acknowledge that any breach of the Policy by me may result in a disciplinary action against me, up to and including termination.

4. I acknowledge that I cannot commence safety sensitive work for R.S. Harris Transport until Ihave submitted a urine sample for testing and the sample has been confirmed as negative for controlled substances.

My signature below confirms that I have read and understood the above terms and that I agree to abide by them.

DatedIn Winnipeg MB

Employee Nameyour full name

SignatureEmployee Signature

(Sign Here)

Clear Signature

To Be Signed by Safety Officer:

Safety Officer Name:

Signature:

Date:

SCHEDULE "D" - ACKNOWLEDGEMENT OF RECEIPT OF R.S. HARRIS'S ZERO TOLERANCE DRUG AND ALCOHOL POLICY (TO BE EXECUTED BY ALL COVERED EMPLOYEES)

MY SIGNATURE BELOW CONFIRMS THAT I HAVE RECEIVED A COPY OF THE ZERO TOLERANCE DRUG AND ALCOHOL POLICY ("the Policy") EFFECTIVE .TUL Y 1, 2006.

I. I understand that I must abide by the terms of the code of conduct, employment agreement, and any other related policies to ensure the safety of my fellow workers and the safety of the public. I further recognize that adherence to the policy is critical to the maintenance of the company's reputation.

2. I understand that as an employee of the Company, I may be required to take an alcohol and/or controlled substance test. I also understand that if refuse to submit to such a test, or tests, that R.S. Harris is obligated to remove me from service and that I may be terminated.

3. I understand that this policy may be changed from time to time with the only notification being the posting of changes on the employee bulletin board.

5. I acknowledge and agree that if I engage in Prohibited Conduct that I will, as a condition of employment, and if I am requested to do so, execute a Last Chance Agreement and that I will abide by all of the terms and conditions set out therein. I understand and agree that I may refuse to execute the Last Chance Agreement but that doing so will have the same effect as tendering my immediate resignation without recourse.

DatedIn Winnipeg MB

Employee Nameyour full name

SignatureEmployee Signature

(Sign Here)

Clear Signature

To Be Signed by Safety Officer:

Safety Officer Name:

Signature:

Date:

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