Do you have any objections to the company checking with your former employer(s) about your work habits and employment records?
Are you legally eligible for work in canada?
Company Address Contact Date started Date finished Reason for leaving
Name Occupation Address Phone number
Priorities Importance Comments
Adequate work load
Home time
A voice on safety concerns
Equipment
Work environment
Performance evaluations
Technology
Wages
Benefits
Training
Job satisfaction
Electronic vs paper log books
Do you understand load securement?
Have you received any safe driving awards from previous employers?
This position requires all employees to be available and willing to travel during the week. Do you have any objections/concerns about being away from home for an extended amount of time? (up to 1 week)
Date Location Type of accident Preventable or non-preventable
Do you have any physical handicaps which would affect your ability to do the job applied for?
To the extent that it would affect your ability to perform the job applied for, are you restricted at all to the use of? Please check if yes
Type Institution From To City Courses
High school
Post secondary
Do you have any physical handicaps which would affect your ability to do the job applied for?

I hereby declare that foregoing information is true and complete to the best of my knowledge. I understand that a false statement may disqualify me from employment or cause my dismissal. I understand also that is this application is for a driving position I may be required to take a company administered road test from time to time at the companies request. Failure to satisfactorily complete this road test may disqualify me from employment or cause my dismissal. If this application is for a driving position, I hereby give my consent to the company to obtain a copy of my driving record from the appropriate government authority.

I hereby acknowledge that any job offer may be conditional upon the passing of a medical examination requested by the company and as administered by a company appointed doctor. I understand that failure to meet the companies standard pertaining to a medical fitness is sufficient cause to disqualify me from employment.