Online Application 

If you are applying for a drivers position please ensure you send us the following supporting documentation: CVOR, Abstract, and CPIC.

Contact Information

 Please fill in the following information:

First Name        
Last Name
Address
Apt/Suite         
City         
Province 
Postal Code
Home Phone     
Cell Phone         
Work Phone 
Email Address

Position Applying For:            

If Other, Please Specify:

                        Location:            

Education: 

Please complete a box for each level of education completed. 

Highest Level Completed
Institution Attended 
Paper Sought 
Progress
Date of Completed
Name of Institution 
Program of Study: 
Specialization:
2nd Highest Level Completed
Institution Attended 
Paper Sought 
Progress
Date of Completed
Name of Institution 
Program of Study: 
Specialization:
3rd Highest Level Completed
Institution Attended 
Paper Sought 
Progress
Date of Completed
Name of Institution 
Program of Study: 
Specialization:
4th Highest Level Completed
Institution Attended 
Paper Sought 
Progress
Date of Completed
Name of Institution 
Program of Study: 
Specialization:
5th Highest Level Completed
Institution Attended 
Paper Sought 
Progress
Date of Completed
Name of Institution 
Program of Study: 
Specialization:

 

Employment History

Please complete the information bellow for previous/current positions you have held:  

Company #1: 

Name of Company          
Address
Phone Number                       
Fax Number                            
Position Title                           
Reason for Leaving
Year Started
Year Completed                      

Please Describe your role, duties, locations traveled, and equipment used: 

May we contact this employer?   Yes      No 

Company #2: 

Name of Company          
Address
Phone Number                       
Fax Number                            
Position Title                           
Reason for Leaving
Year Started
Year Completed                      

Please Describe your role, duties, locations traveled, and equipment used: 

May we contact this employer?   Yes      No 

Company #3: 

Name of Company          
Address
Phone Number                       
Fax Number                            
Position Title                           
Reason for Leaving
Year Started
Year Completed                      

Please Describe your role, duties, locations traveled, and equipment used: 

May we contact this employer?   Yes      No 

Company #4: 

Name of Company          
Address
Phone Number                       
Fax Number                            
Position Title                           
Reason for Leaving
Year Started
Year Completed                      

Please Describe your role, duties, locations traveled, and equipment used: 

May we contact this employer?   Yes      No 

Company #5: 

Name of Company          
Address
Phone Number                       
Fax Number                            
Position Title                           
Reason for Leaving
Year Started
Year Completed                      

Please Describe your role, duties, locations traveled, and equipment used: 

May we contact this employer?   Yes      No 

Company #6: 

Name of Company          
Address
Phone Number                       
Fax Number                            
Position Title                           
Reason for Leaving
Year Started
Year Completed                      

Please Describe your type of work, role, duties, locations traveled, equipment used and any other information you would like us to know: 

May we contact this employer?   Yes      No 

 

Additional Skills

Please describe and list any additional and abilities you may have in the box below. 

 

Equipment Experience 

Please complete the following questions to give us a better understanding of what equipment experience you have.

 

What types of equipment can you operate? 

Diesel   Gas   Propane 

 

What types of transmissions are you experienced with?

5DP   6     9   10     13   15     Twin Stick   Other,

 

What types of trailers are you experienced with? 

Hydraulic Dump   Tanker    A Trains   B Trains    Flat Beds   Floats    Containers

Vans  Livestock  Reefer   Other:

 

Do you have experience with any of the following:

Steel/Metal  Lumber  Petroleum  Food  Clothing   Perishables  Chemicals  Furniture  

Other:

 

What types of work have you had past experience with?

Highway  City Work  Over the Road  Hand Bombing  Other:

 

Have you had experience working with any of the following:

Steel    Gasoline  Reefer  Tarps  Chains  Forklifts   Chains/Binders

Other:

 

Other Information

Are you applying for a driving position?

Yes  No

If yes, Do you have more than 7 months of professional (AZ or DZ) driving experience?

 Yes  No

Have you ever received any safe driving awards? 

 Yes  No

What are your employment goals? 

 

If hired do you have your own reliable transportation to get to and from work?

 Yes  No

Is there anything else you would like us to know? 

 Yes  No

I hereby declare that the forgoing information is true and correct to the best of my knowledge. I understand that a false statement may disqualify me from employment or cause dismissal. I also understand that if this application is for a driving position, that I may be required to periodically take a company administered road test at the company’s request. Failure to satisfactorily complete this road test may disqualify me from employment or cause my dismissal. If this application is for a driving position, I hereby give my consent to the company to obtain a copy of my driving record from the appropriate government authority. Should the company hire me, it may undertake to obtain copies of my driving record as and when the company may so require without further consent.

 By checking this box I agree to the above and confirm that all information provided is correct.   

I hereby acknowledge that any job offer may be conditional upon the passing of a medical examination requested by the company and as administered by a company appointed physician. I understand that failure to meet the company’s standards pertaining to medical fitness is sufficient cause to disqualify me from employment or cause my dismissal.

 By checking this box I agree to the above and confirm that all information provided is correct.   

Human Resources
Copyright © 1999 The Westchester Staffing Group. All rights reserved.
Revised: June 08, 2011 .