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DRIVER’S APPLICATION FOR EMPLOYMENT
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SIN #
Postion Applied For
Driver
Second Choice
Corporation Name
Legal Status in Canada
Citizen
PR
Work Permit
WCB #
GST #
Full Name
Date of Birth
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YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
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1994
1993
1992
1991
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1953
1952
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1950
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1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Cell #
Home #
Email
*
LAST YEAR ADDRESS HISTORY
From or Before
To
Address
Address Line 1
City
State / Province / Region
Postal Code
From or Before (copy)
To (copy)
Address (copy)
Address Line 1
City
State / Province / Region
Postal Code
DRIVER LICENSE INFORMATION
Issuing Province
Driver License Number
Driver License Class
Driver License Condition
Date / Time
1) Do you hold driver license in any other jurisdiction other than the mentioned above or do you hold any driver license in any other name?
Yes
No
2) Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes
No
3) Has any license, permit or privilege ever been suspended or revoked?
Yes
No
4) Has you ever tested positive or refused to submit alcohol or controlled substance test?
Yes
No
5) Have you any injury or medical condition which might affect your job (convulsive disorder, epilepsy, fainting, or heart disease etc.)?
*
Yes
No
Since one of the above answer is YES, Please explain here :
DRIVING EXPERIENCE
Tractor Semi-Trailer
Years
Dry Van / Reefer
Years
Turn Pike / Super B
Years
Manual Transmission
Years
Chassis Trailer
Years
Long Haul
Years
Dump Truck
Years
Flatbed Trailer
Years
US Driving
Years
Straight Truck / 5 Ton
Years
Tanker / Bulk Trailer
Years
Winter Driving
Years
Next
EMPLOYMENT HISTORY
Instructions :
(1) The applicant must provide the following information on all employers during the preceding 3 years.
(2) Provide additional 7 years infomation on those employers for whom the applicant operated commercial motor vehicle.
(3) Provide complete mailing address, street number, city, state, and postal code.
(4) Do not write “See resume" in this section.
(5) List employers in 'reverse order starting with the most recent. Add another sheet as necessary.
Start Date
End Date
Name of Employer
Complete Address
Contact Person
Contact Number
Position Held
Reason for Leaving
Driving Experience
Semi-Trailer
Reefer
Flatbed
Tanker/Bulk
Dump
Super B/Turnpike
Were you subject to the FMCSRs while employed?
Yes
No
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
No
Any gap in employment must be explained. Include dates and reason:
Start Date
End Date
Name of Employer
Complete Address
Contact Person
Contact Number
Position Held
Reason for Leaving
Driving Experience
Semi-Trailer
Reefer
Flatbed
Tanker/Bulk
Dump
Super B/Turnpike
Were you subject to the FMCSRs while employed?
Yes
No
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
No
Any gap in employment must be explained. Include dates and reason:
Start Date
End Date
Name of Employer
Complete Address
Contact Person
Contact Number
Position Held
Reason for Leaving
Driving Experience
Semi-Trailer
Reefer
Flatbed
Tanker/Bulk
Dump
Super B/Turnpike
Were you subject to the FMCSRs while employed?
Yes
No
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
No
Any gap in employment must be explained. Include dates and reason:
Next
EMPLOYMENT HISTORY
Instructions :
(1) The applicant must provide the following information on all employers during the preceding 3 years.
(2) Provide additional 7 years infomation on those employers for whom the applicant operated commercial motor vehicle.
(3) Provide complete mailing address, street number, city, state, and postal code.
(4) Do not write “See resume" in this section.
(5) List employers in 'reverse order starting with the most recent. Add another sheet as necessary.
Start Date
End Date
Name of Employer
Complete Address
Contact Person
Contact Number
Position Held
Reason for Leaving
Driving Experience
Semi-Trailer
Reefer
Flatbed
Tanker/Bulk
Dump
Super B/Turnpike
Were you subject to the FMCSRs while employed?
Yes
No
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
No
Any gap in employment must be explained. Include dates and reason:
Start Date
End Date
Name of Employer
Complete Address
Contact Person
Contact Number
Position Held
Reason for Leaving
Driving Experience
Semi-Trailer
Reefer
Flatbed
Tanker/Bulk
Dump
Super B/Turnpike
Were you subject to the FMCSRs while employed?
Yes
No
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
No
Any gap in employment must be explained. Include dates and reason:
Start Date
End Date
Name of Employer
Complete Address
Contact Person
Contact Number
Position Held
Reason for Leaving
Driving Experience
Semi-Trailer
Reefer
Flatbed
Tanker/Bulk
Dump
Super B/Turnpike
Were you subject to the FMCSRs while employed?
Yes
No
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
No
Any gap in employment must be explained. Include dates and reason:
Next
ACCIDENT RECORD
Accident record for past 3 years.
Date
Number of Fatalities
Location
Number of Injuries
Nature of Accident
Hazardous Material Spill
Yes
No
Date
Number of Fatalities
Location
Number of Injuries
Nature of Accident
Hazardous Material Spill
Yes
No
Date
Number of Fatalities
Location
Number of Injuries
Nature of Accident
Hazardous Material Spill
Yes
No
TRAFFIC CONVICTIONS
Traffic conviction penalties for the past 3 years.
Date
Location
Charge
Penalty ($)
Date
Location
Charge
Penalty ($)
Date
Location
Charge
Penalty ($)
TO BE READ AND SIGNED BY APPLICANT
I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history.
l authorize my prospect employer to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only, if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.
I agree that, if hired, I will immediately inform my employer in writing of any violations or accidents that occur while I am operating any motor vehicle. I will also immediately inform my employer of any suspensions, restrictions, prohibitions, or any other change in the status of my driver's licence.
By signing this application I certify 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. 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 required to abide by all rules and regulations of the Company.
I have read the above stated terms and conditions.
Name
*
Date
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Email
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