Job Opportunities - Owner Operator

JOB OPPORTUNITIES - OWNER OPERATOR

PERSONAL

First Name

Middle Initial

Last Name

Present Address

City

Province/State

Postal Code

Country

Date of Birth

Telephone

Job Applied For

How did you learn of this opening?

Do you want to work Full-time Part-time

Specify days and hours if part-time

Have you worked for us before? Yes No

If yes, when?

If hired, on what date will you be available to start work?

Are there any other experiences, skills or qualifications which you feel would especially fit you for work with us? Please exclude activites which would indicate any prohibited grounds of discrimination listed above.

If hired, do you have reliable means of transportation to get to work? Yes No

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS
(Other than parking violations)

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes No

Has any license, permit, or privilege ever been suspended or revoked? Yes No

IF THE ANSWER TO EITHER A OR B IS YES, PRESENT STATEMENT GIVING DETAILS UPON INTERVIEW

EXPERIENCE AND QUALIFICATIONS - DRIVER

Driver Licenses: State

License No.

Type

Expiration Date

Driver Licenses: State

License No.

Type

Expiration Date

Driver Licenses: State

License No.

Type

Expiration Date

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE
(PRESENT SHEET UPON INTERVIEW IF MORE SPACE IS NEEDED)

Last Accident Date

Nature of Accident (Headon, rearend, upset, etc.)

Fatalities

Injuries

Next Previous Accident Date

Nature of Accident (Headon, rearend, upset, etc.)

Fatalities

Injuries

Next Previous Accident Date

Nature of Accident (Headon, rearend, upset, etc.)

Fatalities

Injuries

PERSONAL REFERENCES
Give the names of at least 3 persons who can supply information pertinent to your job performance (excluding former employers or relatives).

1. Name & Occupation

Address

Phone Number

2. Name & Occupation

Address

Phone Number

3. Name & Occupation

Address

Phone Number

4. Name & Occupation

Address

Phone Number

5. Name & Occupation

Address

Phone Number

Have you ever suffered an injury or illness that would affect your ability to do the job in which you are applying for Yes No

Do you have a valid Passport? Yes No

Occasionally the form of an application blank makes it difficult for an individual to adequately summarize their complete background. To assist us in finding the proper position for you in our company, use the space below to summarize any additional information necessary to describe your full qualifications.

Thank you for completing this application form and for your interest in employment with Cottonwood Commodities Inc. We would like to assure you that your opportunity for employment with this company will be based on your merit and on no other consideration.

PLEASE READ CAREFULLY
APPLICANT'S CERTIFICATE AND AGREEMENT

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause of dismissal. Submitting this application by electronic file constitutes your agreement that all statements set forth are true

I understand