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Join Our Team
Name
First
*
Middle
Last
*
Phone
*
Cell
List addresses for past
three
years
Street
City
Province
Postal Code
How Long?
Street
City
Province
Postal Code
How Long?
Street
City
Province
Postal Code
How Long?
Date of birth
Answer only if applying for driving position
In case of
Name
Address
Phone
Position applied for
Referred by
Physical History
Please describe any positions, jobs, or duties for which you should not be considered because of physical, medical, or mental disabilities:
Have you been granted a waiver under section 391.49 of the federal motor carrier safety regulations pertaining to the loss of foot, leg, hand, or arm? (For drivers only)
Driving Experience
Straight Truck
Type of equipment
(Van, tank, flat, etc.)
From
To
Approximate number of miles
Tractors and Semi-Trailer
Type of equipment
(Van, tank, flat, etc.)
From
To
Approximate number of miles
Twin-Trailers
Type of equipment
(Van, tank, flat, etc.)
From
To
Approximate number of miles
Other
Type of equipment
(Van, tank, flat, etc.)
From
To
Approximate number of miles
Years
Education
Highest Grade Completed
1
2
3
4
5
6
7
8
Highschool
1
2
3
4
College
1
2
3
4
Last School Attended
Name
Address
Show special course or training that will help you as a driver.
Which safety driving awards do you hold and from whom?
General
Have you ever been charged with a criminal offence for which you have not received a pardon?
Yes
No
Is there any reasons you might be unable to perform the functions of the job you have applied?
Yes
No
Have you ever worked for this company in the past?
Yes
No
Record of Hire
Note: D.O.T. requires that hire for at least 10 years be shown
Employer's Name
Supervisor's Name
Address
Phone
Position Held
From
M / Y
To
M / Y
Reason for leaving
Employer's Name
Supervisor's Name
Address
Phone
Position Held
From
M / Y
To
M / Y
Reason for leaving
Employer's Name
Supervisor's Name
Address
Phone
Position Held
From
M / Y
To
M / Y
Reason for leaving
Employer's Name
Supervisor's Name
Address
Phone
Position Held
From
M / Y
To
M / Y
Reason for leaving
Traffic Convictions and Forfeitures For The Past
5
Years CND or US
Other Than Parking Violations
I have no violations
Location
Date
Charge
Penalty
Location
Date
Charge
Penalty
Location
Date
Charge
Penalty
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Yes
No
Details
Have any license, permit, or privilege ever been suspended or revoked for any reason?
Yes
No
Details
Have you ever been disqualified subject to section 391 of the Federal Motor Carrier Safety Regulations?
Yes
No
Details
Any Accident / Incidents Review For Past 5 Years
Dates, city, province / state
Nature of accident or incidents (Scraps, dints, head-on, rear-end, upset, etc.)
Fatalities
Injuries
Dates, city, province / state
Nature of accident or incidents (Scraps, dints, head-on, rear-end, upset, etc.)
Fatalities
Injuries
Dates, city, province / state
Nature of accident or incidents (Scraps, dints, head-on, rear-end, upset, etc.)
Fatalities
Injuries
Dates, city, province / state
Nature of accident or incidents (Scraps, dints, head-on, rear-end, upset, etc.)
Fatalities
Injuries
Dates, city, province / state
Nature of accident or incidents (Scraps, dints, head-on, rear-end, upset, etc.)
Fatalities
Injuries
