19470 – 94th AVENUE, SURREY, BC V4N 4E5  
TELEPHONE: 888-777-0101

LEASE OPERATOR’S EMPLOYMENT APPLICATION
PERSONAL INFORMATION
 

First Name
Middle Name
Last Name

Number and Street
Apt#

City
Province
Postal Code
 

Home Phone


Birth Date
Cell Phone


Citizenship



Do you have a FAST Card



 
DRIVERS LICENSE
 
Province: Class: Number: Expiry:
 
ADDRESS FOR LAST THREE YEARS (if different from above)
 

Number and Street
Apt#

City
Province
Postal Code
 
EMERGENCY CONTACT
 

Name
Relationship
Phone
 
 
Have you worked with this company before
(If yes)      
From
To

Reason for Leaving

 
Is there any reason you may be unable to
perform the functions of this position?

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
Province
 

Contact
Phone

Reason for leaving
 
Was this position subject to to Federal Motor Carrier
Safety Regulations (US)?
Was this position subject to a DOT regulation alcohol
and controlled substance testing program?
 
#2

Company
Position

Start Date
End Date

Address 		 

City
Province
 

Contact
Phone

Reason for leaving
 
Was this position subject to to Federal Motor Carrier
Safety Regulations (US)?
Was this position subject to a DOT regulation alcohol
and controlled substance testing program?
 
#3

Company
Position

Start Date
End Date

Address 		 

City
Province
 

Contact
Phone

Reason for leaving
 
Was this position subject to to Federal Motor Carrier
Safety Regulations (US)?
Was this position subject to a DOT regulation alcohol
and controlled substance testing program?
 
#4

Company
Position

Start Date
End Date

Address 		 

City
Province
 

Contact
Phone

Reason for leaving
 
Was this position subject to to Federal Motor Carrier
Safety Regulations (US)?
Was this position subject to a DOT regulation alcohol
and controlled substance testing program?
 
#5

Company
Position

Start Date
End Date

Address 		 

City
Province
 

Contact
Phone

Reason for leaving
 
Was this position subject to to Federal Motor Carrier
Safety Regulations (US)?
Was this position subject to a DOT regulation alcohol
and controlled substance testing program?
 
#6

Company
Position

Start Date
End Date

Address 		 

City
Province
 

Contact
Phone

Reason for leaving
 
Was this position subject to to Federal Motor Carrier
Safety Regulations (US)?
Was this position subject to a DOT regulation alcohol
and controlled substance testing program?
 
Each of the above entries MUST be complete and accurate. The information contained in this section may be used, and previous employers will be contacted, for the purpose of investigating your safety performance history, as required by FMCSR 391.23 (d) and (e). You have the right to review; have errors corrected by previous employers and resubmitted; and/or have a rebuttal statement attached to your application.

 
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 or
the United States?
Has any license, permit or privilege to operate a motor vehicle ever been suspended or revoked
in Canada or the United States?
Have you been placed out of service in Canada or the United States because of violations regarding
hours of service or vehicle condition – past 2 years?
 
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 STATES/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: Conventional: Wheelbase:
Date of Purchase or Lease Start: Purchase Price:
Own Trailer: If Yes, Type:
 
TENOLD TRANSPORTATION’S REQUIREMENTS
 
1. All units must be capable of licensing in Canada and the United States
2. All Owner Operators and/or their Drivers must be able to drive in the United States
3. All Owner Operators and/or their drivers guarantee they have no outstanding tickets in Canada or the United States.
4. All Owner Operators and/or their Drivers agree to drug testing as a condition of employment.
5. 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.
6. All Owner Operators and/or their Drivers will be required to join CLAC.
7. 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.

Did an owner-operator currently working here refer you to Tenold Transportation?
If so, who?

Signature: (*Type your Full name here as Signature)
Company Name: