Position Applying For

 

Owner Operator ( Van Flat Tandem Flat Heavy Expedite ) or Company Driver

 

Date : Year Month Day

 

* (Required)  FULL NAME: D/L #: CLASS            

STREET: APT:  S.I.N.

 

CITY: PROV./STATE: POSTAL CODE:

 

PHONE: HOME: MOBILE: PAGER:

 

 

Employment History

Company Name / Address

Supervisor Name

Phone #

Start Date/ Finish Date

1

 

 

 

 

 

Reason for leaving:

 

 

 

 

2

 

 

 

 

 

Reason for leaving:

 

 

 

 

3

 

 

 

 

 

Reason for leaving

 

 

 

 

 

 

 

CHECK

YES

NO 

Have you participated in a random drug testing program?

Are you bondable?

Do you have cross border experience/ and familiar with Canada/ U.S. Customs Procedures?

Are you able to enter the USA?

Do you give us permission to contact your previous employer (s)?Please sign Information section below

 

If you are an owner operator please provide the following:

 

 

Truck Information                                                                               Type:

Econo

Van

Stake 

Tractor

 

 

Details:

 

Make

 

Model

 

Year

 

 

 

 

 

 

 

Trailer Type Flat Van Reefer Tanker

Drop Deck Double Drop Trombone

# of axles: 2 3 4 5 6+

Flatbed has: Rack & Tarp

Roll-Tarp Tarps Only

Vans: 48ft 53ft

Special Equip.:

Chains Straps

Steel Hauling- Equipment

 

 APPLICANT INFORMATION

 I Hereby authorize you to release the following information to LASER TRANSPORT INC. for the purposes of investigation as required by Section 391.23 of the Federal Motor Carrier Safety Regulations.  You are released from any and all liability, which may result from furnishing such information.

 Applicants Name:

DATE:

 X  ( Applicants "Electronic" Signature ) By filling in this box you acknowledge and allow Laser Transport and it's Human Resources Department the authority to contact the previous employers that you have listed on the above form.

 

   After clicking on submit you will be redirected to the Laser Transport Home Page.