| Date
of Application: |
|
| Name of Applicant: |
|
| First |
|
| Middle |
|
| Last |
|
| |
|
| Owners/Principal
Officers: |
|
| Telephone # |
|
| Cell # |
|
| |
|
| Present Address: |
|
| Street |
|
| City |
|
| Province |
|
| Postal Code |
|
| Date of Birth |
|
| Social Insurance
No. |
|
| |
|
| Driver License
# |
|
| |
|
| A: Have you ever
been denied a license, permit or privilege to operate a motor vehicle
|
Yes |
| B: Has any license,
permit or privilege ever been suspended or revoked. |
Yes |
| (If answer to
either A or B is yes, attach statement giving details) |
|
| |
|
| If Owner Operator,
what is the expiry date of your tractor inspection: |
|
| Do you have the
legal right to work in the United States? |
Yes |
| Have you worked
for this company before: - if yes when? |
|
| How many years
driving a commercial vehicle do you have? |
|
| What position
are you applying for: |
|
| Driver |
|
| Driver In Training |
|
| Owner/Operator |
|
| Are you employed
now? |
Yes |
| If not, how long
since leaving last employment? |
|
| DRUG & ALCOHOL
RANDOM POOL |
|
| Did you participate
in a Random Drug & Alcohol pool in the last 30 days? |
Yes |
| Did you participate
in a Random Drug & Alcohol pool continuously for the last 12 months? |
Yes |
| Have you been
tested within the last 6 months? |
Yes |
| Who referred
you? |
|
