Contact Information:

Fields with an * are mandatory

Licence:

Has your licence ever been suspended or revoked for any reason, or have you ever been denied a licence for any reason?

Yes (If so, please explain.)
No

Hiring Standards:

Do you have a valid AZ Licence?*

Yes No

Do you have a clean CVOR and Driver's Abstract?*

Yes No

Are you legally eligible to work in Canada?*

Yes No

Can you cross the border into the United States?*

Yes No

Do you have a current Fast Card?*

Yes No

Do you current have a TWIC Card?

Yes No

Are you willing to be tested for drug & alcohol use on a random basis?

Yes No

Do you have any physical limitations we should be aware of?

Yes No

Tractor/Trailer Driving Experience:

Indicate your commercial driving experience:

Less than 1 year
1 - 4 years
5 - 9 years
10 + years

Commercial Vehicles Driven?

Flatbed
Tanker
Multiple Trailer
Other

Truck Information:

What is your reason for choosing us as your potential employer?

Have you been referred by a current driver or Owner Operator? If yes please state their name.

Please specify how you heard about this position?

Release Clause

This certifies that I completed this form myself, and that all entries and information on/in it are said to be true and completed to the best of my knowledge. In the event of employment, I understand that false or misleading information given on this form or interview(s) if said to be, may result in termination.

I authorize T.D. Smith Transport Ltd, to make such investigations and inquires as may be necessary to arrive at an employment decision. This can include my personal history, employment history, driving record, criminal record, drug and alcohol test results from previous employers and other related matters. Generally, inquires regarding medical history will be made only if required and after a conditional offer of employment had been extended.

If hired, this authorization shall remain on file , and I shall complete the required Contract and Full Form Application for T.D.Smith Transport Ltd. I understand that T.D. Smith Transport may need to make this information available to a second party and I authorize this as my written consent.

I agree to supply the following information upon interview:

Original Driver Cvor/Abstract, and Criminal Search(current within 30 days).

I certify that all information contained on this form is complete and accurate to the best of my knowledge.

Date:

Apply to be a Owner Operator