West Coast Transportation Rate Request

West Coast TRANSPORTATIONEMPLOYMENT APPLICATION

1015 HARGRIEVE ROAD LONDON ON N6E 1P6 PHONE: 519-685-2150 FAX: (519) 686-0854 ROBIN ENGLISH Email: [email protected]

IMPORTANT NOTE: You are welcome to return this application by attaching it to an email message. However, any information that has been entered into this form may be subject to interception. In the interest of protecting your privacy, we recommend that you please fill in the blanks, print your completed form and then mail or fax it to West Coast Transportation at the above address or fax number.

To complete and return by email: 1. Press the TAB or ENTER key to move from box to box. 2. When done, from the File menu click Send To, select Mail Recipient (As Attachment). 3. Enter the email address: [email protected] and 4. Click Send to return.

PERSONAL INFORMATION First Name: Middle Name: Last Name: Street Address: City: Province/State: Postal/Zip Code: Phone: Alternate Phone: Fax: Date of Birth: JOB INFORMATION Are you applying for a Company Driver Position? YES NO Are you applying for an Owner-Operator Position? YES NO Drivers License Issuing Prov/State: Date of Expiry: Number: When did you obtain your Class 1A (AZ)? How many years experience do you have pulling Reefers? How many years experience do you have driving for Flatbeds? How many years experience do you have driving for a Van? (WE REQUIRE A MINIMUM OF 2 YEARS DRIVING EXPERIENCE) Are you able to obtain an RCMP Clearance Certificate? YES NO Do you have a FAST Card? YES NO In the past 3 years, how many moving violations have you had? In the past 3 years, how many accidents/violations have you had? In the past 5 years, how many employers have you had? Have you ever been denied a license, permit or privilege to YES NO operate a vehicle? Has any license, permit or privilege ever been suspended or YES NO revoked? If the answer is yes to either of these questions, please provide full details:

Thank-you for your interest in West Coast Transportation.