19470 – 94th AVENUE, SURREY, BC V4N 4E5
TELEPHONE: 800-371-0094
LEASE OPERATOR'S EMPLOYMENT APPLICATION - CANADA ONLY
PERSONAL INFORMATION
Last Name
First Name
Middle Name
Number and Street
Apt#
City
Select Province
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Province
Postal Code
Home Phone
Cell Phone
E-mail Address
DRIVERS LICENSE
Province:
Select Province
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Class:
Number:
Expiry:
ADDRESS FOR LAST THREE YEARS (if different from above)
Number and Street
Apt#
City
Select Province
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Province
Postal Code
EMERGENCY CONTACT
Name
Relationship
Phone
Have you worked with this company before
Yes
No
(If yes)
From
To
Reason for Leaving
Is there any reason you may be unable to
perform the functions of this position?
Yes
No
Explain (if you wish)
EMPLOYMENT HISTORY
Employment history must cover a total of
TEN UNINTERRUPTED YEARS
. List employers starting with the most recent and going back in chronological order. Provide an explanation for any gaps.
#1
Company
Position
Start Date
End Date
Address
City
Select Province
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Province
Contact
Phone
Reason for leaving
#2
Company
Position
Start Date
End Date
Address
City
Select Province
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Province
Contact
Phone
Reason for leaving
#3
Company
Position
Start Date
End Date
Address
City
Select Province
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Province
Contact
Phone
Reason for leaving
#4
Company
Position
Start Date
End Date
Address
City
Select Province
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Province
Contact
Phone
Reason for leaving
ACCIDENT RECORD FOR THE PAST 3 YEARS
Date
Type of Accident
Fatalities
Injuries
Last Accident
Next Previous
Next Previous
MOTOR VEHICLE CONVICTIONS FOR THE PAST 3 YEARS (except parking)
Location
Date
Charge
Fine
Have you ever been denied a license, permit or privilege to operate a motor vehicle in Canada?
Yes
No
Has any license, permit or privilege to operate a motor vehicle ever been suspended or revoked in Canada?
Yes
No
Have you been placed out of service in Canada because of violations regarding hours of service or vehicle condition – past 2 years?
Yes
No
If the answer to question A, B or C. above is yes, please give explanation below:
DRIVING EXPERIENCE
Type of Equipment
Date From
Date To
Miles or Years
Straight Truck
Tractor/Trailer
A or B Train
Other
List provinces operated in for the last 5 years:
OTHER EXPERIENCE AND QUALIFICATIONS
LIST SAFE DRIVING AWARDS AND FROM WHOM
EDUCATION
Highest Grade Completed:
College/University:
Last school attended:
City:
TRUCK INFORMATION
Make:
Year:
Color:
Tare Weight:
Cab Over:
YES
NO
Conventional:
YES
NO
Wheelbase:
Date of Purchase or Lease Start:
Purchase Price:
Own Trailer:
YES
NO
If Yes, Type:
TENOLD TRANSPORTATION’S REQUIREMENTS
1. All units must be capable of licensing throughout Canada
2. All Owner Operators and/or their drivers guarantee they have no outstanding tickets in Canada
3. All Owner Operators and/or their Drivers agree to drug testing as a condition of employment
4. All Owner Operators and/or their Drivers must provide a list of all Drug and Alcohol programs they have participated in during the past three years and sign a release of information form for each previous employer.
5. All Owner Operators and/or their Drivers will be required to join CLAC
6. This certifies that I completed this application form and that all entries on it and information in it are true and complete to the best of my knowledge. I further agree to submit to a Drug and/or Alcohol Test if required by law in Canada or the United States or Company Policy.
How did you hear about Tenold Transportation:
Signature:
(
*Type your Full name here as Signature
)
Company Name:
