Application Form

General Information

(IF YOU HAVE A QUESTON ABOUT THE APPLICATION PLEASE CALL)

1. Personal Details

2. Residence Information

List your addresses of residency for the past 3 years.
Current Address

Check this box if Previous Address and Current Address are the same.

Previous Address

EmploymentHistory

3. EMPLOYMENT HISTORY

In order to drive in Canada you must provide the following information on all employers during the past 3 years.List complete mailing address, street number, city, state, province and or zip codes.
(NOTE:List employers starting with the most recent.)
Employment Details

PLEASE ATTATCH YOUR 3-YEAR COMMERCIAL ABSTRACT. IT MUST BE DATED WITHIN 30 DAYS OF THE APPLICATION DATE

Attach a Document

AccidentRecord

Accident Record for Past 3 years or more. If None, leave blank.

Date
Nature of Accident
Fatalities
Injuries
LAST ACCIDENT
NEXT PREVIOUS
NEXT PREVIOUS

Traffic Convictions And Forfeitures For the Last 3 years. If None, Leave Blank.

Date
Location
Charge
Penalty

Experience & Qualifications

4. Education Profile

5. EXPERIENCE AND QUALIFICATIONS – DRIVER – List all held licenses

IF THE ANSWER TO EITHER A or B is YES, ATTACH STATEMENT GIVING DETAILS.

6. DRIVING EXPERIENCE

Class of Equipment
Type of Equipment(Van, Tank, Flat, Etc.)
Date
Approx # of Total Miles
STRAIGHT TRUCK
TRACTOR/ Semi Trailer
TRACTOR/ 2 Trailers
OTHER

Other Information

7. EXPERIENCE AND QUALIFICATIONS- OTHER

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 investigations and inquires of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquires regarding medical history will made only if and after a conditional offer of employment has been extended). I hereby release employers, schools, helath care providers and other persons from all liability in responding to inquiries and releasing information in connection wuth my application.
In the event of 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 responsible for all costs associated with traffic violation tickets, DOT violation tickets, repairs, and towing costs believed deemed to be due to my own fault. I understand also, that I am required to abide by all rules and regulations of the Company.