Employment Application

First Name

Last Name

Applying for positions:

For more than one position,
hold CTRL + click

Mailing Address

City

Prov

Postal

Day Phone

Evening Phone

E-Mail

Newspaper
School/College
Website

Job Line
Friend/Relative
Employment Agency

Other

Salary Requirements:

Date Available:

If you are interested in a driving position, do you have more than 3 traffic violations or have you been convicted, pled guilty, no contest, forfeited bond or bail for any traffic violations in the past three years?	Yes No
	If Yes, Please Explain

Do you have a valid Drivers License?	Yes No
Do you have a valid commercial driver's license?	Yes No
Have you applied with Door to Dump before?	Yes No	Date:
Have you ever worked for or known anyone that has worked for Door to Dump?	Yes No
If hired, can you provide proof that you are over the age of 18 and eligible to work in Canada?	Yes No
If hired, can you perform the essential duties of the position for which you are applying, with or without accommodation?	Yes No
Are you currently employed?	Yes No	Days Notice:
May we contact your present employer?	Yes No
Have you been convicted of a felony within the past seven years?	Yes No
Have you ever been convicted of, pled guilty or "no contest" to or had any unresolved charges related to a criminal offense involving dishonesty or a breach of trust such as fraud, theft, forgery or other similar crimes?	Yes No
Do you have any commitments to another employer, such as a non-compete or non-disclosure agreement that may affect your employment with Door to Dump?	Yes No

School & Location	Course of Study	Years Completed	Diploma/Degree

High School:


College or University:


Graduate or Professional:


Other: (self education, seminars, volunteerism, military training, special language abilities, memberships of professional organizations, etc.)

Provide name, address, and telephone number of three professional references (i.e. previous employers and/or supervisors).

Name:	Address:	Phone:

Name:	Address:	Phone:

Name:	Address:	Phone:

Please fill out this section completely even if resume is attached and begin with most recent employer; include military service.

Company Name:		Employed From:	Starting Position:	Starting Salary:
Address:		Employed To:	Ending Position:	Ending Salary:
Supervisor:	Phone Number:	Reason for Leaving:
Responsibilites and Details:

Company Name:		Employed From:	Starting Position:	Starting Salary:
Address:		Employed To:	Ending Position:	Ending Salary:
Supervisor:	Phone Number:	Reason for Leaving:
Responsibilites and Details:

Company Name:		Employed From:	Starting Position:	Starting Salary:
Address:		Employed To:	Ending Position:	Ending Salary:
Supervisor:	Phone Number:	Reason for Leaving:
Responsibilites and Details:

If available, please paste your resume below:

I certify that all statements on this form are true and complete to the best of my knowledge. I further understand and agree that any misrepresentation or omission by me on this form will result in the cancellation of further consideration or termination of my employment.
I authorize the Company to investigate information concerning my previous employment, education and training. I hereby hold harmless from liability all persons on account of such disclosure. I understand that the investigation may include verification of past employment, education, driving record, conviction criminal history, and review of personnel records maintained by any prior employer including opinions of reference.
I understand that as a final step in the hiring process, I may be subject to a urine drug screen for illegal drugs, unauthorized use or abuse of prescription drugs, as well as alcohol abuse. Applicants who confirm positive on a drug or alcohol screen may not be considered for employment, or employment may be terminated if already employed. I agree to immediately notify the company if I should be convicted of a felony, or any crime involving dishonesty or a breach of trust while my job application is pending, or during my period of employment, if hired.
I understand and agree that, if hired, my employment is at will, it is for no definite period of time, and may be terminated at any time.
I hereby acknowledge that I have read the above statements and understand and agree to what I have read.

I Agree

info@doortodump.com 604-835-2292