Driver Application

Pete and Annie's Trucking Inc.
140 Wigle Ave Kingsville,
ON N9Y 2J9
Phone: 519 733 6331
Fax: 519 712 8925
     

Personal Data
*Name:

*Date:

 //
  First Middle Last   mm/dd/yyyy
*Address:
  Street Address Apartment/Unit#
 
City Prov. Postal
*Phone: ()   Mobile Phone: ()
Fax ()   *Email Address:
*Position Applied for (check one): Company Driver Owner/Operator Contractor's Driver
*Are you a Canadian's citizen ?

YES

NO

 If 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 ? YES NO    
If yes, explain:
 
Previous address for the past two years:
Address:   From:   To:
Address:   From:   To:
Address:   From:   To:
Address:   From:   To:
               

Driving Qualifications and Experience

*Driver Licenses (Licenses and permits held
during the past 3 years)

 Province/State License Number Class Endorsements Expiration Date
     
*Have you ever been denied a license, permit or privilege to operate a motor vehicle? YES NO If yes explain when and why?
         
*Have any of your license ever been suspended or revoked? YES NO If yes how long and why?
         

*Driving Experience

 Class of Equipment From (mm/yyyy) To (mm/yyyy) Approximate number of total miles
Straight Truck / /
Tractor - Semi-Trailer / /
Tractor - Two Trailer / /
Tractor - Three Trailer / /
Other / /
     
*List all Provinces and States operated in during the past 5 years:
   
List any Safe Driving Awards you hold and from whom:
     
Accident record for the past 3 years:

(attach separate sheet if more space is needed)

 Date of Accident Nature of Accident
(head-on, rear-end upset etc.)  		Location of Accident Number of  Fatalities Number of Injuries
     
Traffic conviction and forfeitures for the past 3 years (other than parking violation):
(attach separate sheet if more space is needed) Date Location Charge Penalty
     

Employment History
     
*Company:

*Phone:

 ()
*Address:

*Supervisor:
*Job Title: *Starting Salary $ *Ending Salary: $
*Responsibilities:
*From: *To: *Reason for Leaving:
*May we contact your previous supervisor for a reference? YES NO
     
Company:

Phone:

 ()
Address:

Supervisor:
Job Title: Starting Salary $ Ending Salary: $
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference? YES NO
     
Company:

Phone:

 ()
Address:

Supervisor:
Job Title: Starting Salary $ Ending Salary: $
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference? YES NO
     
Company:

Phone:

 ()
Address:

Supervisor:
Job Title: Starting Salary $ Ending Salary: $
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference? YES NO
     

Education
 
High School: Address:
From: To: Did you graduate? YES NO Diploma:
                 
College/ University: Address:
From: To: Did you graduate? YES NO Degree:
                 
Other: Address:
From: To: Did you graduate? YES NO Degree:
                 
Are you presently studying? YES NO Course: Where:
             
What are your future plans for additional education?
   

References
 
Full Name: Relationship:
Company: Phone: ()
Address:
       
Full Name: Relationship:
Company: Phone: ()
Address:
       
Full Name: Relationship:
Company: Phone: ()
Address:
       

Disclaimer and Signature
 

I certify that the above information provided by me is true and complete to the best of my knowledge. Should this application lead to emplyment and it is later discovered that false or missing information was provided in this application, any supporting documents, or during my interview, I understand that such falsification will constitute sufficient grounds for dismissal.

 
Signature: Date:
*Security Code:    
  (Please enter the security code shown below. All letters are in capital)    
 
    * Required