Kos Oilfield Transportation

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Required Fields *

Step 1 of 9: Personal Information

Date:	* (dd/mm/yyyy)
Position Applied For:	*
First Name:	*
Last Name:	*
Initials:
Email Address:
Phone Number:	*
Date of Birth:
Address:	*


City:	*
Province:	*
Postal Code:	* (eg. T0L0K0)

Step 2 of 9: Training

Training in: (Include expiry date or ticket # if applicable)

First Aid:
CPR:
H2S Alive:
TDG:
WHIMIS:
GODI:
OHC:
DEFENSIVE DRIVING:
AIR BRAKES:
PICKER TICKET:

Step 3 of 9: Drivers License Information

Do you hold a current driving license?	Yes No
If So, Please give the following information:
Current Number of Demerits:	*
No one will be hired as a driver with ten or more demerits.
Driver License Number:	*
Expiration Date:	* (dd/mm/yyyy)
Province of Issue:	*
Highest Class of License:	*
List all driving convictions and vehicle accidents during the last 5 years:

I give permission for a driver's abstract to be obtained on myself. Please type AGREE in the box to agree:	*

Step 4 of 9: Education

Name of School:	*
Date Last Attended:	* (dd/mm/yyyy)
Type of Certificate or Diploma obtained:	*
Further Education:

Step 5 of 9: Employment History (Present or Most Recent Employer First)

NAME	POSITION	DATES WORKED	REASON FOR LEAVING
1.
2.
3.

If employed, how soon could you start?
Please give the names of any friends or relatives employed by us:

Have you worked for Artie Kos or Babco in the past?	Yes No
If so, please state the reason for leaving:

Step 6 of 9: Personal Interests

List any hobbies and interests that you have:

This is a physically demanding job. is there any medical problems or disabilities that we should be aware of?	Yes No
If so, please list:

Step 7 of 9: References

Please give the names, addresses and telephone numbers of two people who may be contacted for reference

First Person:

Name:	*
Address:	*
City:	*
Province/State:	*
Country:	*
Postal Code:	*
Home Phone:	*
Work Phone:
Cellular:

Second Person:

Name:	*
Address:	*
City:	*
Province/State:	*
Country:	*
Postal Code:	*
Home Phone:	*
Work Phone:
Cellular:

Step 8 of 9: Emergency Contact Information

In the event of an emergency, please list two people to be contacted:

NAME	RELATIONSHIP	PHONE NUMBER
1. *	*	*
2. *	*	*

Step 9 of 9: Verify Information Accuracy

By Typing ACCEPT in the following box, I verify that all of the above information is true and correct, to the best of my knowledge.

If employed, all coveralls issued remain company property. I authorize payroll deductions to cover anything I charge on company accounts for personal use or for the value of unreturned coveralls should I become unemployed.

If you agree, please type ACCEPT: *

Phone number where you can be reached: *

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