Driver Application
In order to properly process this application you may do either of the following:

  • Complete the application below
  • Print it
  • Sign the printed copy in appropriate areas
  • Fax printed copy to 519-695-2249
    (attn: Randy Badiuk)
or
  • Complete the application below
  • Press "send" button
General Information
Full Name:
Social Insurance:
Address:
City:
 Province:
Postal Code:
Birth Date: mm dd yyyy
Home Phone #:
Message Phone #:
Driver's License #:
Province:
Class:
Has your license ever been revoked?
 Yes No  
If yes, please explain:
Have you ever been convicted of a criminal offense for which you have
not received a pardon? Yes No
If yes, please explain:
Any moving violations in the last three years? Yes No
If yes, please explain:
Any accidents, regardless of fault, in the last three years? Yes No
If yes, please list and explain:
Employment History (please provide your work history for the past 3 (three) years)
Last Employer :
Company:
Phone #:
Position:
Address:
City:
Province:
Dates:   
 
Rate of Pay:
From:
To:
Type of equipment operated:
 
Province/States operated in:
Reason for leaving:
2nd Last Employer :
Company:
Phone #:
Position:
Address:
City:
Province:
Dates: 
Rate of Pay:
From:
To:
Type of equipment operated:
 
Province/States operated in:
Reason for leaving:
3rd Last Employer :
Company:
Phone #:
Position:
Address:
City:
Province:
Dates:   
Rate of Pay:
From:
To:
Type of equipment operated:
 
Province/States operated in:
Reason for leaving:
4th Last Employer :
Company:
Phone #:
Position:
Address:
City:
Province:
Dates:   
Rate of Pay:
From:
To:
Type of equipment operated:
 
Province/States operated in:
Reason for leaving:
Please explain any gaps in employment:
Work Preference :
Full Time Part Time Owner Operator
Local Work Middle Distance Long Distance Company Driver
I certify that all the above information contained herein is true and correct. I authorize Harold Marcus Limited. to do a complete background investigation, including past drug and alcohol employment testing results, in accordance with provincial and federal laws. I further authorize my previous employers to release any information requested by Harold Marcus Limited and hold them harmless of all liability from the release of said information.
Applicant's Name: Date:
Please click the submit button only once. Thank you !