..:S & R Trucking:..

Online Driver Application Form

Personal Information
* - Required fields.
Full Name:*
Address:
City:
Province:
Postal Code:
Phone Number:*
Mobile Number:
Fax:
Email:
Date Available if Approved [MM/DD/YYYY]:
Are You an Owner Operator – Yes / No:	Yes No
Best time to contact you:

Driving Information

Driver's License Number:
Class:
Province Licensed In:
License Expiry Date:
Number of Tickets in Last 3 Years:
Number of Accidents in Last 3 Years:
How Many Were Preventable:
Has your License ever been suspended:	Yes No
If Yes, Reason:
Do you have a current Drivers Abstract:	Yes No (within 30 days)
Do you have current Police Clearance:	Yes No (within 6 months)
Do you have a FAST card:	Yes No
Are you currently in a drug testing program:	Yes No

Employment History (Please enter last 10 years work history)

Current employer:
Start date [MM/DD/YYYY]:
End date if unemployed [MM/DD/YYYY]:
City:
Province:
Phone Number:
Job title :
Reason for leaving if unemployed :

Past employer:
Start date [MM/DD/YYYY]:
End date [MM/DD/YYYY]:
City:
Province:
Phone Number:
Job title:
Reason for leaving:

Past employer:
Start date [MM/DD/YYYY]:
End date [MM/DD/YYYY]:
City :
Province:
Phone Number:
Job title:
Reason for leaving:

Truck Driving School Information

Name of Driving School:
City:
Province:
Final Score Percentage:

Additional Information

Where did you hear about us?
Can you work legally in Canada:	Yes No
Can you legally enter the U.S.:	Yes No
Years of experience:
Experience on:	Ocean Containers Dry van/ Reefer Flat bed Tanker Straight truck
Provinces/States Operated in:
Special Courses:
Special Abilities:
Languages Fluent in:
Comments:

Agreement
I hereby authorize any of my former employers to furnish their records of my service, my reason for leaving their employ together with any other information they have concerning me whether on record or not. I hereby release them from any liability for damage whatsoever for issuing it. I also grant permission to include me in an unidentifiable resume where identification is possible. It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not. I agree to furnish such additional information and complete such examinations to complete my employment file. I also understand misrepresentation or omission of information or facts may result in my rejection or dismissal. I also certify that all statements above are, to the best of my knowledge are true.
I Agree:
Date: