Driver Application

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Driver Application

DRIVER EMPLOYMENT APPLICATION

PERSONAL INFORMATION:

Date:

Position Applied For:

Name:

Social Insurance Number:

Nationality:

Address:

City:

Province:

Postal Code:

Cell Phone:

WCB:

GST #:

Date of Birth:

Emergency Contact:

Applicant’s Email:

Previous Address (if not longer than three years at the above address):

Address:

City:

Prov:

Postal Code:

Have you previously worked for this company?

If yes, dates previously worked from:

Position:

Are you presently employed?

If no, for how long since your last position?

Where did you hear about us?

What rate of pay did you expect?

License Information

Has your License, permit or privilege to drive ever been suspended or revoked?

If so, explain why:

Have you ever applied for a license in a different province? If yes, which province:

Do you still hold that license?

EDUCATION INFORMATION:

What is the highest education level you completed?

School/ College/University (last attended):

Driving Training School:

MEDICAL HISTORY:

Do you have any physical limitations that would impair your ability to perform the position you have applied for? If yes, what?

Are you physically capable of heavy lifting and manual work?

How much time have you lost from work in the last three years due to sickness or injury?

Have you ever been tested for drugs?

Do you permit us to contact your previous employers regarding your results?

DRIVING EXPERIENCE:

Class of Vehicles:	Type of Vehicle: (Truck, Van, Tank, Grain)	For How Long? (Years)	Total Miles Driven? (Approx.)
Taxi:
Tractor / Trailer:
Dump / Tow / Grain:
Van:
Bus:
Truck:

Describe any other trucking/ transportation experience/s that will assist you in working for this Company:

TRAFFIC VIOLATION RECORD:

1^st Offense:

Date: Nature of Violation: Location: Fines / Tickets / Charges if any: Fatalities if any: Injuries if any:

2^nd Offense:

Date: Nature of Violation: Location: Fines / Tickets / Charges if any: Fatalities if any: Injuries if any:

3^rd Offense:

Date: Nature of Violation: Location: Fines / Tickets / Charges if any: Fatalities if any: Injuries if any:

ACCIDENT RECORD:

Date	Type of Accident	Fatalities	Injuries

Employment History

Name:

Position:

Address:

From:

City:

Prov.:

To:

Tele:

Fax:

Reason for Leaving:

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the Drug and Alcohol testing requirements of 49 CFR Part 40?

Yes

Employment History 2

Name:

Position:

Address:

From:

City:

Prov.:

To:

Tele:

Fax:

Reason for Leaving:

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the Drug and Alcohol testing requirements of 49 CFR Part 40?

Yes

TO BE READ AND SIGNED BY THE APPLICANT:

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

I authorize you to make any investigations or inquire into my personal, medical history and other related matters that may be necessary to reach a decision regarding my employment.

Driver will be fined $500 for every fail CVSE inspection or any OOS.

I release all persons from all liability in responding to inquiries made in connection with this application.

If I am hired, I understand that false or misleading information given in this application or subsequent interview(s) may result in termination from the employment.

I also understand that I am required to abide by the rules, regulations and procedures as laid down in the company’s policies.

I understand that I will be on a 6-month probation period where I can be terminated anytime without warning.

I understand that should I wish to terminate my employment with the company, I will hand in two weeks’ written notice in advance and my final payment will be given to me 60 days from the date of the letter.

Date:

Print Name:

Signature of Applicant:

ASSESSMENT REPORT:

Criteria	Superior	Good	Average	Poor
Application
Interview
Past Experience
Driving Record
Road Test

Driver Application

DRIVER EMPLOYMENT APPLICATION

PERSONAL INFORMATION:

License Information

EDUCATION INFORMATION:

MEDICAL HISTORY:

DRIVING EXPERIENCE:

TRAFFIC VIOLATION RECORD:

1st Offense:

2nd Offense:

3rd Offense:

ACCIDENT RECORD:

Employment History

Employment History 2

TO BE READ AND SIGNED BY THE APPLICANT:

ASSESSMENT REPORT:

1^st Offense:

2^nd Offense:

3^rd Offense: