QGC Application Date of Application MM slash DD slash YYYY Date Available to Begin MM slash DD slash YYYY Position Applied For Owner/Operator Company Driver FT PT Local/City Driver Other Name First Middle Last Address Street Address City State / Province / Region ZIP / Postal Code Drivers License Number Telephone NumberCellular NumberWho referred you to our company? Have you been convicted of a criminal offense for which a pardon has not been granted? Yes No Have you ever been denied entry into the United States of America? If Yes, explain:Are you a FREE AND SECURE TRADE (FAST) Approved Driver? Yes No If Yes, please provide Registration No. If No, please explain:Employment HistoryALL DRIVER APPLICANTS TO DRIVE A COMMERCIAL MOTOR VEHICLE MUST PROVIDE THE FOLLOWING INFORMATION OF PREVIOUS EMPLOYMENT AS REQUIRED BY REGULATIONS. (NOTE: LIST EMPLOYERS IN REVERSE ORDER STARTING WITH THE MOST RECENT. PLEASE PROVIDE A MINUMUM OF YOUR LAST 5 YEARS OF EMPLOYMENT. PLEASE ADD ANOTHER SHEET AS NECESSARY.) Employer 1 Employer's Name Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Contact Person First Last Telephone Number Date Started MM slash DD slash YYYY Date Finished MM slash DD slash YYYY Position Held Salary/Wage Reason For LeavingEmployer 2 Employer's Name Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Contact Person First Last Telephone Number Date Started MM slash DD slash YYYY Date Finished MM slash DD slash YYYY Position Held Salary/Wage Reason For LeavingEmployer 3 Employer's Name Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Contact Person First Last Telephone Number Date Started MM slash DD slash YYYY Date Finished MM slash DD slash YYYY Position Held Salary/Wage Reason For LeavingReferences (not relatives)Reference 1 Name Years Known Occupation Telephone Number Reference 2 Name Years Known Occupation Telephone Number Reference 3 Name Years Known Occupation Telephone Number Reference 4 Name Years Known Occupation Telephone Number General InformationHas Your Driver's License Ever Been Suspended? Yes No If Yes, Please ExplainAre You Bondable? Yes No If No, Please ExplainHas A Bond For You Ever Been Refused? Yes No If Yes, Why and When?Do You Have Any Objection To The Comapny Talking With Your Former Employer(s) About Your Work Habits and Employment Record? Yes No If Yes, Please Explain?DURING THE PAST FIVE YEARS HAVE YOU HAD TO REPORT TO THE WORKERS' COMPENSATION BOARD FOR ASSISTANCE WITH A PROBLEM/INJURY WHICH WOULD AFFECT YOUR ABILITY TO PERFORM THE JOB FOR WHICH YOU ARE APPLYING? Yes No If Yes, Indicate the Nature of the InjuryDO YOU HAVE ANY PHYSICAL HANDICAPS WHICH WOULD AFFECT YOUR ABILITY TO PERFORM THE JOB FOR WHICH YOU ARE APPLYING? Yes No If Yes, Please ExplainWhat are your employment goals?What does customer service mean to you?Are there talents or skills you would like to develop?Do you have any specialized skills that might assist in the job you are applying for?Is there anything else you would like us to know about you?EducationHighest Grade Completed in Secondary SchoolPlease enter a number from 1 to 12.Course of Study Type of Certification or Diploma Obtained Special Courses or Training Business, Trade or Technical SchoolPlease enter a number from 1 to 4.Course of Study Type of Certification or Diploma Obtained Special Courses or Training Other Courses, Workshops, or SeminarsDatesNameLocationLicense, Certificate or Diploma Experience and Qualifications - DriverLicensesDriver's License No.Province/StateType (Class)Expiration Date Straight Truck ExperienceType of EquipmentDate FromDate ToApprox. No. of Miles (Total)Tractor & Semi-Trailer ExperienceType of EquipmentDate FromDate ToApprox. No. of Miles (Total)Tractor - Two Trailers ExperienceType of EquipmentDate FromDate ToApprox. No. of Miles (Total)Other Equipment ExperienceType of EquipmentDate FromDate ToApprox. No. of Miles (Total)List Provinces, States, or Territories operated in for last five years Show Special Courses or Training that will help you as a driver Which Safe Driving Awards do you hold and from whom? Experience and Qualifications - OtherShow any trucking, transportation or other experience that may help you in your work for this companyList courses and training other than shown elsewhere in this applicationList special equipment or technical materials you can work with (other than those already shown)Expected rate of pay for position applied for
