Driver's full name


Business name


Phone number

Email

Address


Date of birth

How Long?

SIN#

Address (Street, city, postal code)

Address (Street, city, postal code)

Address (Street, city, postal code)

# Years

# Years

# Years

Name

Relationship

Address

Phone

License No.

What type/class of license do you hold?

State/Province

Expiration date

Do you have a FAST Card?
YesNo
If yes, Card No.

CLASS OF EQUIPMENT

TYPE OF EQUIPMENT (DRYVAN, TANK, FLATBED, ETC.)

From


To

DATES(LIST IN REVERSE ORDER STARTING WITH THE MOST RECENT)

NATURE OF ACCIDENT(HEAD-ON, REAR-END, UPSET, ETC.)

NUMBER OF FATALITIES INJURIES

NUMBER OF INJURIES

HAZMAT SPILLS
YesNo

DATE CONVICTED

LOCATION(STATE OR PROVINCE)

PENALTY

Have you ever been denied a license, permit or privilege to operate motor vehicle?
YesNo
Has any license, permit or privilege ever been suspended or revoked?
YesNo
Have you or ever had any problem with crossing the border?
YesNo
When did you reach Canada?

Do you have the legal right to work in Canada?
YesNo
What is your status in Canada?

Have you worked for this company before?
YesNo
Reason for leaving

If yes explain

If yes explain

If yes explain

What is your study duration (in Canada)?

What is your current Citizenship?

Do you have a Work Visa?

If (yes) dates from-to:

Are you currently employed:
YesNo
Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administrated by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?
YesNo
How did you hear about us?

Who referred you?

If (no) how long since leaving your last employment

Is there any reason you might be unable to perform the functions of the job (Under Sub-contractor) for which you have applied? If yes, please explain