Driver Employement Application

Driver Employement Application

COMPLETE IN FULL OR IT WILL NOT BE CONSIDERED
What is the trucking company name you are Applying for?*
Address of the trucking company you are applying for?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Date of Birth *

MonthDayYear
Date
Heading
SIN number*
Date of Application *

MonthDayYear
Date
POSITION APPLIED FOR*
Date of Hire *

MonthDayYear
Date

PREVIOUS THREE YEARS RESIDENCY
Current Street Address*
Current City*
Current State*
Current Zip Code*
Number of Years at this address?*
Previous Street Address (if Less than 2 Year on above address)
Previous City
Previous State
Previous Zip Code
Number of Years at this address?
Previous Street Address (if Less than 2 Year on above address)
Previous City
Previous State
Previous Zip Code
Number of Years at this address?

LICENSE INFORMATION

No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years; attach additional sheets if needed.
Province of License issued (ON,MB,SK,AB,BC,NB,NS,NF)*
License Number*
License Class*
License Expiration Date *

MonthDayYear
Date

DRIVING EXPERIENCE
Have you driven Semi Tractor & Trailer in Past ( Select Todays date if you do not have any experience)*

YesOther
Start Date*

MonthDayYear
To Date*

MonthDayYear
Approx miles driven

Have you driven Straight Truck in Past

Yes
Start Date

MonthDayYear
To Date

MonthDayYear
Approx miles driven
Have you driven Semi Tractor & 2 Trailer in Past

Yes
Start Date

MonthDayYear
To Date

MonthDayYear
Approx miles driven
ACCIDENT RECORD FOR THE PAST 3 YEARS
Check this box if no accident in past three years

No Accident in past 3 years
First Accident - Date (Leave blank if No Violation)

MonthDayYear
Date
First Accident - NATURE OF ACCIDENT (Head-on, rear-end, upset, etc.) - (Leave blank if No Violation)
First Accient- Injuries (Leave blank if No Injuries)
First Acident - Chemical spills (Mention Yes or NO in the feild below)
First Accident - Fatalities (Leave blank if No Violation)
Second Violation - NATURE OF ACCIDENT (Head-on, rear-end, upset, etc.) - (Leave blank if No Violation)
Second Accident - Date (Leave blank if No Violation)

MonthDayYear
Date
Second Accident - Fatalities (Leave blank if No Violation)
Second Accident - Injuries (Leave blank if No Injuries)
Second Accident - Chemical spills (Mention Yes or NO in the feild below)

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)
Check this box if no Traffic Conviction in past three years

No Accident in past 3 years
First Violation - What kind of Vilation was it? - (Leave blank if No Violation)
First Violation - Date (Leave blank if No Violation)

MonthDayYear
Date
First Violation - In which State (ON,MB,SK,AB,BC,NB,NS,NF)
First Violation - Any Penalty (Forfeited bond, collateral and/or points)
Second Violation - What kind of Vilation was it? - (Leave blank if No Violation)
Second Violation - Date (Leave blank if No Violation)

MonthDayYear
Date
Second Violation - Any Penalty (Forfeited bond, collateral and/or points)
Second Violation - In which State (ON,MB,SK,AB,BC,NB,NS,NF)
Third Violation - What kind of Violation was it? - (Leave blank if No Violation)
Third Violation - Date (Leave blank if No Violation)

MonthDayYear
Date
Third Violation - Any Penalty (Forfeited bond, collateral and/or points)
Third Violation - In which State (ON,MB,SK,AB,BC,NB,NS,NF)
Type a question
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*

YesNo
Has any license, permit, or privilege ever been suspended or revoked?*

YesNo

Education
High School Details
High School Name ( Write NOT APPLICABLE if you have nothing to enter here) *
Which Course did you do in Graduation? ( Write NOT APPLICABLE if you have nothing to enter here) *
What was your Year of Graduation ( Write NOT APPLICABLE if you have nothing to enter here) *
Did You Graduated?( Mark NOT APPLICABLE if you have nothing to enter here)*

YesNoNot Applicable
College Details
College Name ( Write NOT APPLICABLE if you have nothing to enter here) *
Which Course did you do in College ? ( Write NOT APPLICABLE if you have nothing to enter here) *
What was your Year of Graduation at college ( Write NOT APPLICABLE if you have nothing to enter here) *
Did You Graduated at college ?( Mark NOT APPLICABLE if you have nothing to enter here)*

YesNoNot Applicable
TO BE READ AND SIGNED BY APPLICANT

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. 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.In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have the right to:• Review information provided by current/previous employers;• Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer; and• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.
Applicant Name
Signature*

Clear
Date *

MonthDayYear
Date

Cell Phone Usage Policy

At all times, the worker’s first responsibility is to their own personal safety and the safety of other drivers, pedestrians and the passengers in their vehicle.▪ Dispatch is received by cell phone▪ Workers must adhere to all provincial, state or local rules and regulations regarding the use of cell phones/hand held devices while driving. Accordingly, workers must not use such devices if such conduct is prohibited by law, regulation or other ordinance.
Signature*

Clear
Mark Date of Application

MonthDayYear
Date

Driver Disclosure of Convictions and At-FaultTrafficAccidents

I hereby declare that the following is a true and complete list of convictions and accidents required to be reported under the Highway Traffic Act, Sec 318.1(3).
First Violation Date

MonthDayYear
Date
What was the incident of this conviction? (Write NOT APPLICABLE if you have nothing to enter here)*
What was the location of Incident? (Write NOT APPLICABLE if you have nothing to enter here)*
Typer of Vehicle Being Operated during this Incident? (Write NOT APPLICABLE if you have nothing to enter here*
Second Violation Details
Second Violation Date

MonthDayYear
Date
What was the second incident of this conviction? (Write NOT APPLICABLE if you have nothing to enter here)*
What was the location of second Incident? (Write NOT APPLICABLE if you have nothing to enter here)*
Typer of Vehicle Being Operated during this second Incident? (Write NOT APPLICABLE if you have nothing to enter here*
I hereby certify that I have not had any convictions (other than parking and mobile or intersection photo enforcement convictions) or accidents required to be reported under the Highway Traffic Act, Sec 318.1(3) that have occurred while operating any motor vehicle in the previous 12 months.
Signature*

Clear
Name*

First NameLast Name
Mark Date of Application

MonthDayYear
Date

Driver Disclosure of Licence

DeclarationPursuant to Section 318.1(3) of The Highway Traffic Act, I hereby declare that:• I am not licensed to drive in any jurisdiction other than the one named below.• I do not hold any driver’s licence in any other names.• My driver’s licence is valid and is not suspended.• I will immediately inform the motor carrier in writing of any convictions or accidents that occur while I am operating any motor vehicle.• I will immediately inform the motor carrier of any suspensions, restrictions, prohibitions, or cancellation of my driver’s licence
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Licence Number*
Licence Class*
Province*
Employment Application Date*

MonthDayYear
Date
Signature*

Clear

What is the Trucking company name you are Applying for?*
What is the trucking companies Address you are Applying for?*
What is the trucking companies City, State and Zip you are Applying for?*
What is the trucking companies Contact number you are Applying for?*
What is the trucking companies email address you are Applying for?*
What is the contact person's name in the trucking company you are Applying?*

General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I(Your Name),   First Name*   Last Name*   hereby provide consent to (Company Name) blank* to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse.
Is the driver consenting to a single limited query and/or multiple limited queries? Check mark the appropriate
1) Single   Yes*
2) Multiple______
Is the number of limited queries specific or unlimited? Check mark the appropriate
1) Specific ______
2) Unlimited __   Yes*      ____
I understand that if the limited query conducted by the above-mentioned company indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to the above mentioned company without first obtaining additional specific consent from me.
I further understand that if I refuse to provide consent for the above-mentioned company to conduct a limited query of the Clearinghouse, the above mentioned company must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.
Signature*

Clear
Date*

MonthDayYear

PRE-EMPLOYMENT DRUG AND ALCOHOL QUESTIONNAIRE
Name*

First NameLast Name
Within the last three (3) years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work?*

YesNo
If yes, have you successfully completed the return-to-duty process?

YesNo

Upload Following Documents
Driving License*

Browse Files
ONLY PDF FILE CAN BE UPLOADED. PLEASE CONVERT ALL YOUR FILES INTO PDF Cancelof
Driving Abstract*

Browse Files
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Work Permit / PR Card

Browse Files
ONLY PDF FILE CAN BE UPLOADED. PLEASE CONVERT ALL YOUR FILES INTO PDF Cancelof
Anything Else

Browse Files
ONLY PDF FILE CAN BE UPLOADED. PLEASE CONVERT ALL YOUR FILES INTO PDF Cancelof

Should be Empty:

Driver Employement Application

Heading

PREVIOUS THREE YEARS RESIDENCY

LICENSE INFORMATION

DRIVING EXPERIENCE

ACCIDENT RECORD FOR THE PAST 3 YEARS

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)

EMPLOYMENT HISTORY

Second Most Recenet Employer Details

Third Most Recenet Employer Details

Education

High School Details

College Details

TO BE READ AND SIGNED BY APPLICANT

Cell Phone Usage Policy

Driver Disclosure of Convictions and At-FaultTrafficAccidents

Second Violation Details

I hereby certify that I have not had any convictions (other than parking and mobile or intersection photo enforcement convictions) or accidents required to be reported under the Highway Traffic Act, Sec 318.1(3) that have occurred while operating any motor vehicle in the previous 12 months.

Driver Disclosure of Licence

General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

PRE-EMPLOYMENT DRUG AND ALCOHOL QUESTIONNAIRE

Upload Following Documents