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EMPLOIS DISPONIBLES

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CONSENT TO RELEASE PERSONAL INFORMATION

This form concerns the verification and obtaining of information necessary for the further evaluation of your application for employment purposes.

I authorize GROUPE GUILBAULT LTD. to verify and obtain all information and personal information from my former employers and/or any other organization concerning my duties, reputation and other information that may be relevant to my application.

I therefore authorize all concerned to disclose the information requested.

In the event of a hiring, any request for personal information is made according to the terms and conditions of the Act respecting the protection of personal information in the private sector (L.R.Q. 1996, ch.P-39.1).

I certify that all the information contained in this form is true and complete. I am aware that a false statement may result in the rejection of my application or my dismissal.

If you are applying for a forklift operator position, please complete this section.

Do you have a forklift driver card?

Do you have a WHMIS card?

FORKLIFT DRIVING EXPERIENCE

FORKLIFT DRIVING ACCIDENTS AND INCIDENTS

During the past five years, have you been involved in any accident or incident while driving a forklift?

If you are applying for a driver position, please complete this section.

Manual transmission indication (M)

Air brake indication (F)

Long combination vehicle indication (T)

Ontario pneumatic S-cam brake adjustment certificate

Ontario wheel system maintenance certificate

Are you familiar with the Air-brake system?

Transportation of dangerous goods certificate

Have you ever been refused a commercial vehicle driver’s licence?

Has your licence ever been revoked or suspended?

Do you have an additional driver’s licence issued by another jurisdiction?

Have you ever tested positive for controlled substance in the past three years?

Have you ever refused a required test for drugs or alcohol in the past three years?

Do you have a FAST card?

DRIVING EXPERIENCE

Tractor/semi-trailer combination

Flat Bed

Long combination vehicle

Container

Specialized transport

DRIVING TRAINING

Hour of service

Transportation of dangerous goods

Wheels

Preventive driving

Energy efficiency

Daily inspection

Load securing

Air brakes

WHMIS

HEAVY VEHICLE DRIVING ACCIDENTS AND INCIDENTS

During the past five years, have you been involved in any accident or incident while driving?

DRIVING ACCIDENTS AND INCIDENTS

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Have you been referred by an employee? If so, enter their first and last names