Blacks Transfer Ltd.

Full Name*

First Name Last Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

SIN Number*

E-mail*

English level of understanding:*

French level of understanding:*

Phone Number*

- Area Code Phone Number

Position Applied for*

Broker Driver

When can you start?*

Are you a Canadian Citizen?*

Yes No

Can you legally work in Canada?*

Yes No

Can you legally work in the US?*

Yes No

Number of months experience driving a 18-Wheeler in Canada:

Number of months experience driving a 18-Wheeler in the US :

Number of months experience driving a 18-Wheeler in the elsewhere: , please specify country:

Click to Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes No

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

Yes No

Could your border crossing be refused due to a criminal record for which you have not received a pardon?

Yes No

Could your border crossing be refused due to a criminal record for which you have not received a pardon?

Yes, In Canada Yes, In the States No

Could your border crossing be refused due to any other legal or judicial reason? (e.g. road accident, infractions to the Highway Code, problems with American Customs, Immigration, Income tax, IRS or other)?

Yes, In Canada Yes, In the States No

Are you presently involved in any litigation for Highway Code or criminal infractions which could exclude you from performing your chauffeur duties, or which could cause you to lose your driving privileges in Canada or in the USA?

Yes No

During the past 3 years, have you ever been convicted of driving while under the influence of drugs or alcohol?

Yes No

If yes to any of the above, please explain below.

In the preceding 24 months, have you passed drug and alcohol tests at a previous place of employment?

Yes No

Cover Letter*

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