Online Application - Company Driver
*First Name :
Middle Name :
*Last Name :
*Address1 :
Address 2 :
*City :
*Province / State :
*Postal / Zip Code :
*Email Address :
*Telephone :
Alternate Phone :
Driver’s license number :
Class :
Issuing Province :
Date of Expiry :
# of Accidents in the last 3 years :
# of Tickets in the last 3 years :
# of years Tractor/Trailer experience :
Federal law requires that you must be 21 years of age or older to be qualified to operate in interstate commerce. Do you qualify?
Yes No
Are you a Canadian citizen? :
If no, do you have a legal right to live and work in Canada? :
Are you currently admissible into the US? :
Has any license, permit or privilege ever been suspended or revoked? :
If the answer is yes to this question, please provide full details :
Current/Most Recent Employer :
Address :
City :
Province / State :
Postal / Zip Code :
Telephone :
Contact :
Start Date :
Enter Year :
End Date :
Are you presently employed? :
May we contact this employer? :
Employer Name :
I certify that I personally completed this questionnaire and that all the information contained herein is true and correct. I authorize Laidlaw Carriers Van LP to do a complete background investigation in accordance with provincial and federal laws. I authorize my previous employers to release any information, including all information related to my alcohol and controlled substance testing and training records by the Federal Highway Administration (FHWA) 49 CFR Parts 391 or 382 to Laidlaw Carriers Van LP and hold them harmless of all liability from the release of said information.
To continue enter "Laidlaw" into the textbox: Please check this box if you have read and agree to these terms
