* First Name:
* Middle Name:
* Last Name:
* Street Address:
* City:
* Province/State:
* Postal/Zip Code:
   
* Phone #:
Cell #:
* On The Road #:
* Email:
* Comp. or Own\Op?:
Owner / Operator
Truck/year/make
O/OP Name
Unit #
Company Driver
Incorporation Name
If double with
* Date Of Birth:
* Type of License How long
* Miles driven in Canada * Miles driven in US
* Are you bondable?
* Are you legally eligible to enter U.S.A? - Citizenship
* Do you require a waiver to enter U.S.A? - Date of Expires
   
*Brief Questionaire:
Please fill these questions out to the best of your ability. It must be filled out entirely.
*How many moving violations or accidents have you had in the last five years?
Citations: Accidents:
*Has your license ever been suspended, revoked, or denied?
Yes: No: If so, when?:
*Have you ever been charged and convicted of a DWI, DUI, or Reckless Driving?
Yes: No: If so, when?:
*Have you ever been convicted of a felony?
Yes: No: If so, when?:
*Have you ever tested positive for a controlled substance and\or alcohol?
Yes: No: If so, when?:
   
Employment History:
 
Please fill these out to the best of your ability. We require all info from your 8 most recent employers.
 
* Present or Last Employer:
* Position Held:
* From:
* To:
* Reason For Leaving?:
* May We Contact
Your Present Employer?:
Yes
No
* Contact Person:
* Contact Phone:
* City:
* Province/State:
* Postal/Zip Code:
*Second Last Employer:
* Position Held:
* From:
* To:
* Reason For Leaving?:
* Contact Person:
* Contact Phone:
* City:
* Province/State:
* Postal/Zip Code:
Third Last Employer:
Position Held:
From:
To:
Reason For Leaving?:
Contact Person:
Contact Phone:
City:
Province/State:
Postal/Zip Code:
Fourth Last Employer:
Position Held:
From:
To:
Reason For Leaving?:
Contact Individual:
Contact Phone:
City:
Province/State:
Postal/Zip Code:
Fifth Last Employer:
Position Held:
From:
To:
Reason For Leaving?:
Contact Individual:
Contact Phone:
City:
Province/State:
Postal/Zip Code:
Sixth Last Employer:
Position Held:
From:
To:
Reason For Leaving?:
Contact Individual:
Contact Phone:
City:
Province/State:
Postal/Zip Code:
Seventh Last Employer:
Position Held:
From:
To:
Reason For Leaving?:
Contact Individual:
Contact Phone:
City:
Province/State:
Postal/Zip Code:
Eight Last Employer:
Position Held:
From:
To:
Reason For Leaving?:
Contact Individual:
Contact Phone:
City:
Province/State:
Postal/Zip Code:
   
ACKNOWLEDGEMENT: Please read carefully and initial below

I acknowledge, understand and certify that I am legally entitled to work in Canada. Load Solutions Inc. may verify my work record and qualifications. I hereby authorize my previous employers to release my work record for the purpose of employment with Load Solutions.

Any false or misleading statements made by me on this application shall be just cause for my dismissal whenever such statements may be discovered. I may be required to pass a medical examination and drug test before I can be officially employed. This application was completed by me and; is true and complete to the best of my knowledge.

* Initials:   

Contact

  • LSI Load Solutions Inc.
    Mason Rd. Puslinch,
    (Cambridge) Ontario
    N3C 2V4
  • Telephone: 519-824-2222

  • LSI Load Solutions Inc.
    6855 Columbus Rd,
    Mississauga, Ontario
    L5T 2G9
  • Telephone: 905-564-2244

  • Fax: 905-248-3196