Verspeeten Cartage Ltd.

Application for Employment
274129 Wallace Line, Ingersoll, ON, N5C 3J7

(Please answer all questions and print clearly)
Position applying for:*
Date
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Previous Addresses:*
Date To: Date From: Address

Please list any addresses which you resided in during the 3 years preceding the date the application was submitted:
Home Phone #:*
Cell Phone #:*
Email
Emergency Contact Name:*
First Last
Emergency Contact Phone #:*
Social Insurance Number*
Driver's License Number*
Driver’s License Expiration Date Month:*
Driver’s License Expiration Date Year:*
List all licenses held in the previous 5 years*
Number State Class

DRIVING EXPERIENCE
DRIVING EXPERIENCE*
Category Accumulated Years Total Miles

Please list all of your Straight Truck, Tractor-Trailer/ Semi Trailer, Tractor - Two Trailers, Heavy Haul - Greater than 80,000 lbs gross, Other (Bus, heavy equipment)
VIOLATION HISTORY*
Date Description Location Penalty

List any driving or other violations you have been convicted of in the previous 3 years regardless of what you were driving. Please put N/A if it does not apply to you.
ACCIDENT HISTORY*
Date Description (rollover, side-swipe, etc.) Injuries Fatalities

List all accidents that you have been involved in the past 3 years regardless of what vehicle you were driving. Please put N/A if it does not apply to you.

PREVIOUS EMPLOYMENT HISTORY
You must list all employers even if it was not trucking related for the past 10 years starting with the most recent*
Employer Address Phone Date Employed from Date Employed to Reason for leaving
Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the testing requirements of 49 CFR 40?*
- Yes
- No

TO BE READ AND SIGNED BY THE APPLICANT
TO BE READ AND SIGNED BY THE APPLICANT
Applicant’s Name:*
First Middle Last
I hereby certify that this application has been completed by me and that all information is true, accurate and complete to the best of my knowledge.

In the event I am employed by Verspeeten Cartage Ltd., I understand that any misleading or false information that I may have given on this application or during any interview(s) may result in the immediate termination of my employment. I also understand that I am required to abide by all company policies and procedures as well as all relevant government regulations.

I hereby grant Verspeeten Cartage Ltd. permission to conduct background and reference checks with all of my former employers unless otherwise stated at the time of application. I understand that these background and reference checks will include relevant information about my work history as well as drug and alcohol testing information as it pertains to the U.S. DOT requirements under 49 CFR 40.
PLEASE TYPE IN YOUR FIRST AND LAST NAME BELOW
Name
First Last
Date*
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1500$ SIGNING BONUS – NOW HIRING FAST AZ APPROVED DRIVERS

Application for Employment