In compliance with Federal and Provincial equal employment opportunity laws, qualified applicants are
considered for all positions without regard to race, colour, religion, sex, national origin, age, marital
status or the presence of a non-job-related medical condition or handicap.
I authorize you to make such investigations and inquiries of my personal, employment, 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, schools, health care providers and other
persons from all liability in responding to inquiries 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 termination. I understand, also, that I am required to abide by
all rules and regulations of the Company.
I understand that information I provide regarding current and/or previous employers may be used, and
those employer(s) will be contacted, for the purpose of investigating my safety performance history as
required by 49 CFR 391.23(d) and (e). I understand that I have the right to:
Review information provided by previous employers;
Have errors in the information corrected by previous employers and for those previous employers to
re-send the corrected information to the prospective employer; and
Have a rebuttal statement attached to the alleged erroneous information if the previous employer(s)
and I cannot agree on the accuracy of the information.
EMERGENCY CONTACT INFORMATION
ADDRESS HISTORY
CURRENT ADDRESS
PREVIOUS 3 YEARS ADDRESS HISTORY
DRIVER LICENCE INFORMATION
STRAIGHT TRUCK
TRACTOR AND
SEMI-TRAILER
TRACTOR- TWO
TRAILERS
OTHER
ACCIDENT RECORD FOR PAST 3 YEARS OR MORE
TRAFFIC CONVICTIONS FOR THE PAST 3 YEARS (OTHER THAN PARKING)
EMPLOYMENT HISTORY
All driver applicants to drive in interstate commerce must provide the following information on all
employers during the preceding 10 years. List complete mailing address, street number, city, province and
postal code .
(NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)
TO BE READ AND SIGNED BY THE APPLICANT
I, certify that this application was completed by me, and that all entries on it and
information in it are true and completed to the best of my knowledge. I authorize (TORONTO COAST
TRUCKING LTD )and their assigned agents, to make such investigations and inquiries of my personal,
employment, financial (credit bureau) information, criminal search, driving abstracts, drug results from
previous employers or their consortium or their insurance carrier or Agent for my driving record,
insurance history, medical history, and other related matters as may be necessary in arriving at an
employment decision.
If hired or contracted, this authorization shall remain on file and shall service as ongoing authorization to
recheck or report as deemed necessary at any time throughout my employment or contract period or
after such period. (Generally, inquiries regarding medical history will be made only if and after a
conditional offer of employment has been extended).
I hereby release employers, schools, health care providers and other persons from all liability in
responding to inquiries 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 discharge.
Furthermore, I understand that (TORONTO COAST TRUCKING LTD )and/or their Agents may keep any
information on file including work performance as related to my employment period and make it
available to any second party only with my verbal or written consent. I understand, also, that I am
required to abide by all rules and regulations of company.
For purposes of gathering this information, I have supplied information which may be required by law
enforcement agencies and other entities for positive identification purposes when checking records,
including Date of Birth, residence history and Driver’s License Number/Province. It is confidential and
will not be used for any other purpose.
9 Holland Drive, Bolton, Ontario, L7E 1G7
New Employee’s Drug and Alcohol Statement – Cross Border Applicants Only
In accordance with 49 CFR 40.25 (j), as the employer, you must ask any prospective employee, whether
he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered
by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work
covered by DOT agency drug and alcohol testing rules during the past two years.
Prospective Employer Name: - TORONTO COAST TRUCKING LTD
Address: - 9 Holland Drive, Bolton, Ontario, L7E 1G7
To be answered by the employee
If the employee admits that he or she had a positive test or refusal to test, you must not use the employee
to perform safety-sensitive functions for you, until and unless the employee documents successful
completion of the return-to-duty process (see 40.25(b)(5) and 40.25(e). [The return-to-duty process is
outlined in Subpart Oof Part 40.
MOTOR CARRIER INSTRUCTIONS: The requirements in Part 383 apply to every driver
who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing
26,001 pounds or more, can transport more than 15 people, or transports hazardous
materials that require placarding.
The requirements in Part 391 apply to every driver who operates in interstate commerce and
operates a vehicle weighing 10,001 pounds or more, can transport more than 15 people, or
transports hazardous materials that require placarding.
DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety
Regulations contain some requirements that you as a driver must comply with. These
requirements are in effect as of July 1, 1987. They are as follows:
POSSESS ONLY ONE LICENSE: You, as a commercial vehicle driver, may not possess more than
one motor vehicle operator’s license. If you have more than one license, keep the license from
your state of residence and return the additional licenses to the states that issued them.
DESTROYING a license does not close the record in the state that issued it; you must notify the
state. If a multiple license has been lost, stolen, or destroyed, close your record by notifying the
state of issuance that you no longer want to be licensed by that state.
NOTIFICATION OF LICENSE SUSPENSION, REVOCATION OR CANCELLATION: Sections 391 .1
5(b)(2) and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your
employer the NEXT BUSINESS DAY of any revocation or suspension of your driver’s license. In
addition, Section 383.31 requires that any time you violate a state or local traffic law (other than
parking), you must report it within 30 days to: 1) your employing motor carrier, and 2) the state
that issued your license (If the violation occurs in a state other than the one which issued your
license). The notification to both the employer and state must be in writing.
The following license is the only one I will possess: -
DRIVER CERTIFICATION: I certify that I have read and understood the above requirements.
Driver /Owner Operator Name
