<% ' ******************************************************************* ' Application Module: IBEEM catch all email ' ******************************************************************* ' DATE INITIALS CHANGES ' 01/01/2002 MT Initial Version ' 09/12/2004 MT Moved to stable code libary ' 28/02/2005 MT Add more database, emails ' 01/08/2005 MT Upgraded email module ' 16/06/2006 MT Upgraded email module all catch formatted ' ******************************************************************** ' DESCRIPTION: This module will format all form values. ' ******************************************************************** ' VARS: request("sendemail")=1 ' REQUIREMENTS: CDONTS ' ******************************************************************** ' ********************************* ' START - Catch all email formatted ' ********************************* if request("sendemail")=1 then if IsEmpty(Session("ASPCAPTCHA")) or Trim(Session("ASPCAPTCHA")) = "" then Response.Write "" else Dim TestValue : TestValue = Trim(Request.Form("txtCaptcha")) TestValue = UCase(TestValue) if StrComp(TestValue, Trim(Session("ASPCAPTCHA")), 1) = 0 then mailbody="" mailbody=mailbody & "" mailbody=mailbody & "Email Message" mailbody=mailbody & "" & Replace(Replace(Replace(Replace((Request.Form), "&", "
"), "=", ":   "), "+", " "), "_", " ") & "
" mailbody=mailbody & "






" mailbody=mailbody & "
" Set Mail = CreateObject("CDO.Message") 'This section provides the configuration information for the remote SMTP server. 'Send the message using the network (SMTP over the network). Mail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/sendusing") = cdoSendUsingPort Mail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/smtpserver") ="localhost" 'Mail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/smtpserverport") = 25 'Use SSL for the connection (True or False) 'Mail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/smtpusessl") = False Mail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/smtpconnectiontimeout") = 60 'If your server requires outgoing authentication, uncomment the lines below and use a valid email address and password. 'Basic (clear-text) authentication 'Mail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/smtpauthenticate") = 1 'Your UserID on the SMTP server 'Mail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/sendusername") ="noreply@scottwoodstransport.com" 'Mail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/sendpassword") ="moa3ief" Mail.Configuration.Fields.Update 'End of remote SMTP server configuration section Mail.Subject="Scott Woods Employment Application for Drivers Form" Mail.From="info@scottwoodstransport.com" Mail.To="info@scottwoodstransport.com" 'Mail.To="doug@3dautomation.ca" Mail.HTMLBody=mailbody Mail.Send Set Mail = Nothing else Response.Write "" end if Session("ASPCAPTCHA") = vbNullString Session.Contents.Remove("ASPCAPTCHA") end if end if ' ************************************* ' END - IBEEM Catch all email formatted ' ************************************* ' ' ******************************************************************* ' End Application Module: IBEEM email user ' Copyright © Acecomp Plus Corporate Site Solutions - www.acecomp.com ' All rights reserved 1997-2006. ' ******************************************************************* ' IBEEM CMS, IBEEM EMS, IBEEM ECMS, IBEEM INTRANET AND IBEEM ECMS+I
' ARE LICENSED BY ACECOMP PLUS UNDER ISLA (IBEEM Software License Agreement). %> Employment Application for Truck Drivers

 

<% if request("sendemail")=1 then %>

Thank you, the form has been submitted.

Click here to return to the site.

<% end if %>

Employment Application for Drivers

 

LASTNAME                                                                                  FIRSTNAME                                                                                     MIDDLE

ARE YOU OVER THE AGE OF 21?

NO                        YES
                              

TODAYS DATE

      

DATE AVAILABLE TO START

 

SOCIAL INSURANCE NUMBER

     

DO YOU HAVE THE LEGAL RIGHT TO WORK IN CANADA ?
     NO                        YES
                          

EXPECTED RATE OF PAY

     

PHONE

     

CELL

     

EMAIL

     

POSITION APPLIED FOR

     

ARE YOU NOW EMPLOYED?

     

HOW LONG SINCE LEAVING LAST EMPLOYMENT?
     

CURRENT ADDRESS                                            street                                          city                                   province                                postal
     

HOW LONG?
     

You must provide addresses for the past three years

PREVIOUS ADDRESS                                            street                                          city                                   province                                postal
     

HOW LONG?
     

PREVIOUS ADDRESS                                            street                                          city                                   province                                postal
     

HOW LONG?
     

PREVIOUS ADDRESS                                            street                                          city                                   province                                postal
     

HOW LONG?
     

IN EMERGENCY NOTIFY
     

EMERGENCY PHONE
     

WHO REFERRED YOU?
     

HAVE YOU WORKED FOR THIS COMPANY BEFORE?
     

EDUCATION/TRAINING

NAME OF SCHOOL

LOCATION

YEARS ATTENDED

DID YOU GRADUATE

COURSE OF STUDY

DEGREE EARNED?

HIGH SCHOOL
     


     

N/A


  

N/A


 

COLLEGE
     


    


     


     


     


     

TRADE/TECH/OTHER
     


     


     


     


     


     

LICENSES

LICENSE TYPE

LICENSE NUMBER

PROVINCE

EXPIRATION


     

 

     


     


     


     


     


     


     

HAVE YOU EVER BEEN DENIED A LICENSE, PERMIT OR THE PRIVILEGE TO DRIVE? IF YES EXPLAIN OR ATTACH DETAILED STATEMENT
    

HAS ANY LICENSE, PERMIT OR PRIVILEGE TO DRIVE BEEN SUSPENDED OR REVOKED? IF YES EXPLAIN OR ATTACH DETAILED STATEMENT
     

 

 

 

 

 

DRIVING EXPERIENCE

CLASS OF EQUIPMENT

TYPE OF EQUIPMENT

(VAN, TANK, FLAT ETC)

DATES FROM

DATES TO

APPROXIMATE NUMBER OF MILES

STRAIGHT TRUCK


     


     


     


     

TRACTOR AND SEMI TRAILER


     


     


     


     

TRACTOR-TWO TRAILERS


     


     


     


     

OTHER


     


     


     


     

LIST PROVINCES , STATES, OR TERRITORIES OPERATED IN FOR LAST FIVE YEARS:

LIST SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER:

LIST ANY OTHER SKILLS OR ABILITIES THAT YOU FEEL WILL HELP IN YOUR WORK FOR THIS COMPANY:

EMPLOYMENT HISTORY (must account for the last ten years)

EMPLOYER

EMPLOYMENT DATES

SALARY

POSITION

NAME
     

FROM
     

STARTING
     

STARTING
     

ADDRESS
     

TO
     

ENDING
     

ENDING
     

SUPERVISOR
     

PHONE
     

REASON FOR LEAVING
     

EMPLOYER

EMPLOYMENT DATES

SALARY

POSITION

NAME
     

FROM
     

STARTING
     

STARTING
     

ADDRESS
     

TO
     

ENDING
     

ENDING
     

SUPERVISOR
     

PHONE
     

REASON FOR LEAVING
     

EMPLOYER

EMPLOYMENT DATES

SALARY

POSITION

NAME
     

FROM
     

STARTING
     

STARTING
     

ADDRESS
     

TO
     

ENDING
     

ENDING
     

SUPERVISOR
     

PHONE
     

REASON FOR LEAVING
     

EMPLOYER

EMPLOYMENT DATES

SALARY

POSITION

NAME
     

FROM
     

STARTING
     

STARTING
     

ADDRESS
     

TO
     

ENDING
     

ENDING
     

SUPERVISOR
     

PHONE
     

REASON FOR LEAVING
     

ACCIDENT RECORD

DATE OF ACCIDENT

(EACH OCCURRENCE)

NATURE OF ACCIDENT

(HEAD-ON, REAR END, ETC.)

PENALTY

INJURIES


     


     


     


     


     


     


     


     

 

 

TRAFFIC CONVICTIONS (excluding parking violations)

DATE OF CONVICTION

(EACH OCCURRENCE)

CHARGE

FATALITIES

INJURIES


     


     


     

  


     


     


     

     

PERSONAL DATA

HAVE YOU EVER BEEN CONVICTED OR PLED NO CONTEST TO ANY CRIMINAL OFFENSE?
     

IF YES, INDICATE NATURE OF OFFENSE, DATE, COURT, AND DISPOSITION.  A CONVICTION DOES NOT NECESSARILY DISQUALIFY AN APPLICANT.
     

IS THERE ANYTHING THAT WILL INTERFERE WITH YOUR ABILITY TO PERFORM, ON A REGULAR BASIS, THE ESSENTIAL DUTIES OF THE JOB YOU ARE APPLYING FOR?
     

HAVE YOU APPLIED TO WORK WITH US BEFORE? IF YES, WHEN?
     

MAY WE CONTACT YOUR CURRENT EMPLOYER?
     

ARE YOU APPLYING FOR FULL TIME, PART TIME, SEASONAL OR TEMPORARY?    

WHAT DAYS AND HOURS WOULD YOU BE AVAILABLE TO WORK, PLEASE CHECK THOSE THAT APPLY:

 

 

SUN

MON

TUES

WED

THURS

FRI

SAT

HOLIDAYS

MORNING

     

     

     

     

     

     

     

     

AFTERNOON

     

     

     

     

     

     

     

     

EVENING

     

     

     

     

     

     

     

     

LIST ALL TYPES OF WORK YOU CAN DO:
     

DO YOU HOLD ANY SAFE DRIVING AWARDS? IF SO, FROM WHOM?
     

LIST ANY OTHER COURSE AND/OR TRAINING THAT YOU FEEL WILL BE BENEFICIAL IN THE POSITION YOU ARE APPLYING FOR:
     

 

TO BE READ AND SIGNED BY THE APPLICANT

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

 

I authorize you to make such investigation and inquiries of my personal employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision.  I hereby release employers, schools, or persons from liability in responding to inquiries in connection with my application.

 

In the event of my employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the Company, as permitted by law.

 

 


                     Applicants Signature                                                         Date         

 

 

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