| Name: |
First |
Middle |
Last |
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| Telephone: |
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Cell: |
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| Email: |
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| Date of Birth: |
mm/dd/yy |
SIN: |
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| Your addresses within the last 5 years, starting with current: |
| Current: |
Address |
City |
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| |
Address |
City |
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| |
Address |
City |
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| Type of driving preferred: (check all that apply) |
| |
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| If you live more than 160 km or 100 miles from our North Bay, Mississauga, Timmins or Sudbury Terminals, are you willing to relocate? |
Yes No |
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| Rate of pay or miles expected per week: |
|
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| How did you hear of ProNorth? |
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| Why did you choose ProNorth? |
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| Have you ever provided driving services for ProNorth? |
Yes No |
| Which Agency? |
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| Why did you leave? |
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| Did a ProNorth employee refer you? |
ProNorth Employee Name |
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| Are you legally entitled to work in the United States? |
Yes No |
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| Have you ever been denied entry to the U.S.? |
Yes No |
|
| Are you legally entitled to work in Canada? |
Yes No |
|
| Do you have a current permit to work outside Canada? |
Yes No |
|
| Have you ever been convicted of a criminal offence? |
Yes No |
| What were you charged with? |
|
| Do you have a waiver I92 or I94 for this offence? |
Yes No |
|
| Are there any medical restrictions or injury that might prohibit you from performing all the duties of a truck driver? |
Yes No |
| If yes, please explain: |
|
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| Why do you want to become a tractor-trailer driver? |
|
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| List 5 responsibilities you think a driver would have other than driving a truck: |
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| If you have a delivery in Chicago, Monday morning at 8am (725 Miles) when would you leave North Bay Terminal with load? Why? |
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| License Details: |
A-Z License Number |
Province |
Expiration Date |
|
| Have you ever been denied a license, permit, or privilege to operate a motor vehicle? |
Yes No |
| Has a license, permit, or privilege ever been suspended or revoked for any reason? |
Yes No |
| If yes, please explain: |
|
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| Driving Experience: |
|
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| Number of A-Z years you can verify: |
|
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| List the provinces and states you have operated in during the last 5 years: |
|
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| Did you have any accidents in the last ten years? If yes, please give the details: |
|
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| Have you driven a vehicle for an employer in the last three years? |
Yes No |
| If yes, name of employer: |
|
|
| Are you presently unemployed? |
Yes No |
| If yes, date unemployment began: |
|
|
| List your current and past employment for the last ten years, beginning with your most recent job first, and explain any gaps in Employment: |
|
| Current or Most Recent Employer: |
Name |
Position |
|
|
Address |
City |
Province |
Postal Code |
|
Contact Person |
Contact Position |
Contact Phone |
Contact Fax |
|
| Reason for leaving: |
|
|
|
| Next Employer: |
Name |
Position |
|
|
Address |
City |
Province |
Postal Code |
|
Contact Person |
Contact Position |
Contact Phone |
Contact Fax |
|
| Reason for leaving: |
|
|
|
| Next Employer: |
Name |
Position |
|
|
Address |
City |
Province |
Postal Code |
|
Contact Person |
Contact Position |
Contact Phone |
Contact Fax |
|
| Reason for leaving: |
|
|
|
| Next Employer: |
Name |
Position |
|
|
Address |
City |
Province |
Postal Code |
|
Contact Person |
Contact Position |
Contact Phone |
Contact Fax |
|
| Reason for leaving: |
|
|
|
| Next Employer: |
Name |
Position |
|
|
Address |
City |
Province |
Postal Code |
|
Contact Person |
Contact Position |
Contact Phone |
Contact Fax |
|
| Reason for leaving: |
|
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| Education: |
|
| Highest Level Completed: |
| High School: |
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| College: |
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| University: |
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| Last School Attended: |
Name |
City |
Province |
Year |
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| Did you attend a Driving School? |
Name |
City |
Province |
Phone |
|
From |
To |
Did you graduate? |
Yes No |
|
| Number of classroom training hours: |
|
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| Number of behind the wheel miles and hours on the road: |
|
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This application will not be complete unless followed by the following |
|
| Drivers Abstract, current within thirty days: |
Yes No |
| CVOR Abstract, current within thirty days: |
Yes No |
| Criminal Record Search, within thirty days: |
Yes No |
| Canadian Medical Certificate: *The medical certificate is the one used to get you’re A-Z Drivers License. |
Yes No |
|
| May we contact all your previous employers for reference checks? |
Yes No |
| If not, please indicate which ones you don't want us to contact: |
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Applicant’s Certification and Authorization
This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.
I hereby authorize you to make such investigations and inquiries of my personal, employment(with above restrictions, if any), financial or medical history and other related matters as may be necessary in arriving at an employment decision ( Generally , inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.)
I hereby release employers, school, health care providers and other persons from all liability in responding to enquiries and releasing information in connection with my application.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate discharge. I understand also, that in the event of employment, I will be required to abide by all Pronorth policies and guidelines and all application legislation.
Furthermore in the event of employment, I hereby consent to submitting to drug testing in accordance with ProNorth’s policies.
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