Drivers Application – Task Carriers

Personal Information

Position applied for*

Temporary
Part Time
Full Time

Name*

First Middle Last

Phone

Current Address

Street Address City Province Postal Code

Address for past 3 years

Other addresses you have lived in for the past 3 years

Street Address City Province Postal Code

Address for past 3 years

Other addresses you have lived in for the past 3 years

Street Address City Province Postal Code

Have you ever been convicted of a crime for which a pardon has not been granted?

Yes
No

Who referred you?

Rate of pay expected?

Have you worked for this company before?

Yes
No

Date: From

Date: To

Where?

Rate of Pay

Position

Reason for Leaving?

Name of any relatives employed by this company?

Are you currently employed?

Yes
No

If not, how long since leaving last employment?

Education

Highest Education Completed: High School Grade:

College Years:

Last School attended?

Last school address:

Physical History

List any handicap that prevents you from doing certain kinds of work.

Are you physically capable of heavy manual work?

Yes
No

Ever injured on the job?

Yes
No

If yes, give the nature and degree of such injuries

How much time lost from work in the past three years for illness?

Will you be willing to take a physical examination?

Yes
No

Driver Experience

List down the Driver's Licenses held in the past 3 years

Click on the plus sign on the right if you have had more than one license

Province	License No.	Class Type	Expiration

Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes
No

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

Yes
No

If yes to any of the above, please write a statement below giving details.

Driver Experience: Straight Truck

Type of Equipment (Van, Tank, Flat, etc.)	Date: To	Date: From	Approximate # KM

Driver Experience: Tractor and Semi-Tractor

Type of Equipment (Van, Tank, Flat, etc.)	Date: To	Date: From	Approximate # KM

Driver Experience: Twin Trailers - LCV's

Type of Equipment (Van, Tank, Flat, etc.)	Date: To	Date: From	Approximate # KM

Driver Experience: Other

Type of Equipment (Van, Tank, Flat, etc.)	Date: To	Date: From	Approximate # KM

List states operated in during last five years

Click on the plus button to add more

List special courses or training that will help you as a driver

List driving awards held and who awards were presented by

Accident Review for Past 3 years

List down accidents you have been involved in for the past 3 years. Click on the plus sign on the right to add more.

Date	Nature of accident (Head-On, Rear-End, Overturn, etc.)	Fatalities	Injuries

Traffic Convictions and Forfeitures for the past 3 years other than parking violations

Click on the plus sign on the right if there are more.

Location	Date	Charge	Penalty

Employment History

Start with last or current position, including military experience, and work back.

Last Employer

Supervisor’s Full Name:

Full Address

Postal Code

Phone

Position Held:

Enter the position held

From:

Month/Year

To:

Month/Year

Salary

Reason for Leaving:

Second Last Employer

Supervisor’s Full Name:

Full Address

Postal Code

Phone

Position Held:

Enter the position held

From:

Month/Year

To:

Month/Year

Salary

Reason for Leaving:

Third Last Employer

Supervisor’s Full Name:

Full Address

Postal Code

Phone

Position Held:

Enter the position held

From:

Month/Year

To:

Month/Year

Salary

Reason for Leaving:

APPLICANT MUST READ AND SIGN

I certify that I have read and understood all of this employment application. It is agreed and understood that the employer may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not, and I release employers and other persons named herein from all liability for any damages on account of furnishing such information.

I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks, which are pertinent to the job. I also understand that if offered a job, it may be conditional on the results of a physical examination and drug test. I certify that I am genuine for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason. If hired, I agree to abide by all the rules and policies of the employer.

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.

Applicant Signature*

Type in your signature

Sign Date*

Enter the sign date

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