Driver Application

First Name

Last Name

Email

Address

Street Address / PO Box

City

Province/State

Postal Code / Zip

Country

Phone Number

How Long have you lived here?

Previous Address (If less than 3 years at current address):

Street Address / PO Box

City

Province/State

Postal Code / Zip

Country

Are you a citizen of Canada?

Yes

No

Are you authorized to work in Canada?

Yes

No

Have you ever worked for this company?

Yes

No

If yes, when?

Have you ever been convicted of a felony for which you have not been pardoned?

Yes

No

If yes, please explain.

Driver's License #

Province

Class

Expiration Date

Driving Experience

Straight Truck

Type of Equipment

Approx. # of KM

From

To

Tractor-Trailer

Type of Equipment

Approx. # of KM

From

To

Trailers

Type of Equipment

Approx. # of KM

From

To

Other

Type of Equipment

Approx. # of KM

From

To

Last Accident

Nature Of Accident

Date

Fatalities

Injuries

2nd Last Accident

Nature Of Accident

Date

Fatalities

Injuries

3rd Last Accident

Nature Of Accident

Date

Fatalities

Injuries

Have you/your driving privileges ever been suspended due to revocation or suspension of your driver's license? If yes, please provide details of this loss of privilege.

Traffic Convictions for the past 3 years or more.
Other than parking violations.

Date

Location

Charge

Penalty

Date

Location

Charge

Penalty

Date

Location

Charge

Penalty

Date

Location

Charge

Penalty

Date

Location

Charge

Penalty

Previous Employer 1

Company

Contact

Contact's Position

Contact's Phone #

Address

Street Address / PO Box

City

Province / State

Postal Code / Zip

Country

From

To

While working for this company were you subject to USDOT regulations?

Yes

No

While working for this company were you subject to alcohol and controlled substance testing as required by 49 CFR Part 40?

Yes

No

Previous Employer 2

Company

Contact

Contact's Position

Contact's Phone #

Address

Street Address / PO Box

City

Province / State

Postal Code / Zip

Country

From

To

While working for this company were you subject to USDOT regulations?

Yes

No

While working for this company were you subject to alcohol and controlled substance testing as required by 49 CFR Part 40?

Yes

No

Previous Employer 3

Company

Contact

Contact's Position

Contact's Phone #

Address

Street Address / PO Box

City

Province / State

Postal Code / Zip

Country

From

To

While working for this company were you subject to USDOT regulations?

Yes

No

While working for this company were you subject to alcohol and controlled substance testing as required by 49 CFR Part 40?

Yes

No

Any Additional Information:

This certifies that I have completed this application, and all entries on it and information in this application are true and comlete to the best of my knowledge.

Driver Application Form

Driving Experience

Tractor-Trailer

Trailers

Other

Last Accident

2nd Last Accident

3rd Last Accident

Previous Employer 1

Previous Employer 2

Previous Employer 3