APPLICATION FOR EMPLOYMENT
Instructions: 1. Please Print   2. Incomplete information could affect the evaluation of your application.
Position applied for:
Type of employment desired
Full-time Part-time Operator Technician Apprentice Other
Personal Data
Last name
 First name
 Initial
 Preferred name
Address (Street #, name)
 Apt. #
City/Town
 Province
 Postal Code
Telephone
Number(s)		 Area Code Number Do you have a valid driver's licence in
good standing?
Yes No
Class: 		How many penalty points do you currently have against your licence?

Date - -
Home:
Office: An NSC Driver’s Abstract, Insurance Claims History and a photocopy of
your Driver’s Licence will be requested if an interview is scheduled.
Cell:
Education
Name of secondary school
 Highest grade or level completed
 Type of certificate or diploma received
Name of business, trade or technical school
 Name of program
 Length of program
 Licence, certificate
or diploma awarded
Yes No
Name of community college
 Name of program
 Length of program
 Licence, certificate
or diploma awarded
Yes No
Name of university
 Name of program
 Length of program
 Licence, certificate
or diploma awarded
Yes No
Other courses, workshops and seminars
Title		 Date Completed
Professional qualifications, memberships and affiliations
Present or Most Recent Employment
Position title
 Duties/Responsibilities
Salary
$ 		Hourly
Annually		 Period or Employment
From: To:
Month
 Year
 Month
 Year
Company name
Address (street #, name)
City/Town
 Province
 Postal Code
Name of immediate supervisor
 Reason for leaving
Department
Telephone #
Ext.
Previous Employment
Position title
 Duties/Responsibilities
Salary
$ 		Hourly
Annually		 Period or Employment
From: To:
Month
 Year
 Month
 Year
Company name
Address (street #, name)
City/Town
 Province
 Postal Code
Name of immediate supervisor
 Reason for leaving
Department
Telephone #
Ext.
Previous Employment
Position title
 Duties/Responsibilities
Salary
$ 		Hourly
Annually		 Period or Employment
From: To:
Month
 Year
 Month
 Year
Company name
Address (street #, name)
City/Town
 Province
 Postal Code
Name of immediate supervisor
 Reason for leaving
Department
Telephone #
Ext.
Additional Information
Use this space if you wish to record any additional information pertinent to the job applied for, not covered in the previous sections.
NOTE: Because some of the factors are job requirements (e.g. valid driver’s licence, professional licence, and entitlement to employment), disqualification of same or change in status may result in re-assignment or termination of employment.
1. At which accredited Driver’s School did you complete your driver’s training and in which year?
Name and location of Driving School Year of completion
2. Do you have an immediate family member working for Diversified Transportation Ltd.? No Yes
3. Have you worked for or been interviewed by Diversified Transportation Ltd. before? Yes No
4. Are you eligible to work in Canada? No Yes
5. You will need your own reliable vehicle to get to and from the bus depot each day. Do you have your own transportation? Yes No
6. Have you attached your resume to this application? No Yes
7. How did you hear about the employment openings with Diversified Transportation? Please check appropriate box.
Word of mouth Employee Referral Internet (Job Bank) Kijijii
Recruitment Fair Diversified Website Advertisement Other (Please specify)
8. Do you have a conviction for a criminal offence for which a pardon has not been granted?
No Yes - specify:
NOTE **A Criminal conviction does not necessarily disqualify you from the position.
Information requested in this application is treated confidentially.

I hereby declare that the foregoing information is true and complete to my knowledge. I understand that only applicants moving forward to the interview stage will be contacted and that a false statement may disqualify me from employment or cause my dismissal.
Please enter your full name    Date:
Pursuant to Section 39(2) of the Freedom of Information and Protection of Privacy Act, you are hereby notified that personal information relating to you is being collected for the purpose of human resources staffing. In the event that you are not selected this application and all personal information collected by Diversified Transportation Ltd. will be destroyed.