POSITION APPLIED FOR (please  check all that apply)

Name (Last, First, Middle):

 

Date of Birth:

 

Street Address:

 

Unit #:

 

City:

 

Province:

 

Postal Code:

 

Phone #:

 

Alternate Phone #:

 

License #:

 

License Classification:

 

E-mail Address

 

Have you ever worked for us before? (click if yes):

 

How did you hear about us?:


Shift

 Days Only
Afternoons Only
Evenings (midnights) Only
No Preference

Location

 Local City Only (Home every night)
Short Highway (Home every other night)
Long Haul
Canada Only
Will you travel to U.S. if necessary?
Are you legally eligible to enter the U.S. (Click if yes)

Type of  Employment

 Full Time Only
Part Time Only
Call In (Spare board)
Will you hand bomb if necessary? (driver assist offload)

EMPLOYMENT RECORD FOR THE THREE YEARS MINIMUM

(Ten for commercial vehicle)

Last or current  employer's name:

Phone #:

Fax #:

Position Held:

Reason for Leaving:

Start  Date:

End Date:

Supervisor's Name:

Phone #:

Fax #:

May we call for a reference check? (click if yes)




Second last or current employer's name:

Phone #:

Fax #:

Position Held:

Reason for Leaving:

Start  Date:

End Date:

Supervisor's Name:

Phone #:

Fax #:

May we call for a reference check? (click if yes)




Third last or current employer's name:

Phone #:

Fax #:

Position Held:

Reason for Leaving:

Start  Date:

End Date:

Supervisor's Name:

Phone #:

Fax #:

May we call for a reference check? (click if yes)

*note* At least 3 years of references will be called prior to employment

Driving Experience

Class of
Equipment
Driven

Years of
Experience

Dates Driven
From > To

Total
KMS.
Driven

Types of
Transmissions used

Straight Truck

Tractor Trailer


Types of
Equipment

Years of
Experience

Dates Driven
From > To

Total
KMS.
Driven

Load Types
I.E.:Steel

Dry Van

Flat Deck

A, or B, Train

Reefer


List any specialized equipment used:


List any specialized loads hauled:


List provinces or states operated in for last five years:


State  any special qualifications you feel would be an asset to United Drivers Services Inc.:


Please list any accident within the past three years:


If you have none please mark "nil" in the appropriate section.

Date

Nature Of Accident

Penalties?

Preventable?
(Click if yes)



Please List All Convictions And Forfeitures For Three Year  Period:

Date

Charges Laid

Convicted?

Personal or
Commercial?



Have you ever been denied a license or permit to operate a motor vehicle in any state or province?

Click if yes

Has any license, permit or privilege ever been suspended or revoked in any state or province?

Click if yes

If the answer to either  question is yes, please make a detailed statement in the space  provided.



Please list three personal references

Name

Phone Number

Relationship to you



You must read and acknowledge the following, before your application will be considered

I hereby declare that the foregoing information  is true and complete to the best of my knowledge. I understand that a  false statement, or failure to accept any, or all company policies, may  disqualify me from employment and/or ensure my dismissal. I understand that prior to being employed I must accept all policies and procedures as outlined in the United Driver Services policy, rules, and  regulations.

 Accept terms