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Application to Sub Contract as an Owner/Operator
Application to Sub Contract as an Owner/Operator
Application for Sub Contract
Date:
*
MM slash DD slash YYYY
Name:
*
Telephone:
*
Address:
*
Postal Code:
*
Social Insurance Number:
*
Age:
*
Date of Birth:
*
Month
Day
Year
Gender:
*
Male
Female
BC Driver's License #:
*
Any Points or Restrictions?:
*
Yes
No
If YES, how many and reason:
How long have you held a valid driver's license:
*
Have you ever been involved in a motor vehicle accident?
*
Yes
No
If YES, please provide detail and extent of injuries if any:
Last grade completed:
*
How well do you know the Lower Mainland?
*
Marital Status:
*
Dependents?
*
Yes
No
Are you bondable?
*
Yes
No
Monthly commission expected:
*
Any health issues that could affect your employment?
*
Yes
No
If YES, please explain:
Availability
Would you like to work full-time or part-time?
*
Full-time
Part-time
Are you willing to work shift work?
*
Yes
No
Vehicle
Make:
*
Model:
*
Year:
*
Colour:
*
Employment Record
Please list most recent jobs. We must have 2 references that you have actually worked for, "Self-employed" will not be considered as a valid reference.
Company:
*
Address:
*
Phone:
*
Supervisor:
*
Start Date:
*
MM slash DD slash YYYY
End Date:
*
MM slash DD slash YYYY
Salary:
*
Reason For Leaving:
*
Company:
*
Address:
*
Phone:
*
Supervisor:
*
Start Date:
*
MM slash DD slash YYYY
End Date:
*
MM slash DD slash YYYY
Salary:
*
Reason For Leaving:
*
Have you received benefits from the Workers Compensation Board?
*
Yes
No
If YES, please provide details:
In The Event of An Emergency
Next of Kin:
*
Address:
*
Home Phone:
*
Work Phone:
*
I certify that the information contained in this application is correct to the best of my knowledge and I understand that deliberate falsification of this information is grounds for termination of contract. I authorize the references listed to give any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release all parties from all liability for any damage that may result from furnishing information to you.
Date:
*
MM slash DD slash YYYY
Signature:
*
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