Mechanic Application

Date of Application:

Position Applied for:

Name:

Address:

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

Phone:

Cell:

Address for the past 3 years:

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

How Long?

Are you bondable:

Have you worked for this company before:

Are you employed at present:

How long since leaving last employer:

Are you FAST Approved:

Are you able to cross the border:

Are you available/willing to work weekends:

Are you available/willing to work flexible hours:

Physical History

List any handicap that prevents you from doing certain kinds of work:

Are you physically capable of heavy manual work:

Have you ever been injured on the job:

Describe:

How much time lost from work in the past three years for illness:

Are you willing to take a physical:

Employment History

All driver applicants must provide the following information on all employers during the preceding 5 years. Please list employers starting with the most recent.

Employer:

Date from:

To:

Address:

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

Phone:

Position held:

Rate of pay:

Reason for leaving:

Employer:

Date from:

To:

Address:

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

Phone:

Rate of pay:

Position held:

Reason for leaving:

Employer:

Date from:

To:

Address:

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

Phone:

Position held:

Rate of pay:

Reason for leaving:

Employer:

Date from:

To:

Address:

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

Phone:

Position held:

Rate of pay:

Reason for leaving:

Accident record for the past 3 years:

Date

Location

Describe:

Date

Location

Describe:

Education

Highest grade completed:

College:

Last school attended:

Training:

Experience and Qualifications

Driver's License Class:

Have you ever been denied a license permit or privilege to operate a motor vehicle:

Has your license, permit or privilege ever been suspended or revoked:

If yes, please explain:

Years commercial experience:

Approx. # of miles driven:

Straight Truck Type:

Dates from:

To:

Tractor/Trailer Type:

Dates from:

To:

Tractor/Trains Type:

Dates from:

To:

List states/provinces operated in for the last 5 years:

Training and qualifications:

To Be Read & Agreed Upon by Applicant

This certifies that this application was completed by myself, and that all information given is true and complete to the best of my knowledge.

I authorize DOBBIN TRANSPORTATION to make such investigations and inquire of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, or persons from all liability in responding to inquiries in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) my result in discharge. I also understand that I am required to abide by all rules and regulations or the company, as permitted by law.

I agree to the above:*

Yes

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EMPLOYMENT APPLICATION FOR MECHANIC

Physical History

Employment History

Accident record for the past 3 years:

Education

Experience and Qualifications

To Be Read & Agreed Upon by Applicant

Driver Application

Office Administration

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