Truck Driver Application Trucking Application Form Lotus Terminals Job Application First Name*Middle NameLast Name*Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country How Long At This Address?*select< 1 year2 years3 years4 years4+ yearsPrevious Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country If current address less than a year, indicate your previous addressLicense InformationProvince Of License*BCAlbertaSaskatchewanManitobaOntarioQuebecNova ScotiaNew BrunswickYukonClass*Expiration Date* Driving Experience1. Class Of Truck Equipment Straight Truck Tractor & Semi Trailer Tractor - Two Trailers Other Other ClassType Of EquipmentVan, Tank, Flat, etc.Date From Date To Approx. No. Of Miles2. Class Of Truck Equipment Straight Truck Tractor & Semi Trailer Tractor - Two Trailers Other Other ClassType Of EquipmentVan, Tank, Flat, etc.Date From Date To Approx. No. Of Miles3. Class Of Truck Equipment Straight Truck Tractor & Semi Trailer Tractor - Two Trailers Other Other ClassType Of EquipmentVan, Tank, Flat, etc.Date From Date To Approx. No. Of Miles4. Class Of Truck Equipment Straight Truck Tractor & Semi Trailer Tractor - Two Trailers Other Other ClassType Of EquipmentVan, Tank, Flat, etc.Date From Date To Approx. No. Of MilesAccident Record Please include the last 3 years of driving.Date Nature Of Accident(Rear-End, Upset, etc.)Number Of FatalitiesNumber Of InjuriesChemical SpillsYesNoDate Nature Of Accident(Rear-End, Upset, etc.)Number Of FatalitiesNumber Of InjuriesChemical SpillsYesNoDate Nature Of Accident(Rear-End, Upset, etc.)Number Of FatalitiesNumber Of InjuriesChemical SpillsYesNoDate Nature Of Accident(Rear-End, Upset, etc.)Number Of FatalitiesNumber Of InjuriesChemical SpillsYesNoTRAFFIC CONVICTIONS / FORFEITURES Please include the last 3 years of driving. Do not include parking violations.Date Convicted ViolationLocation of ViolationPenaltyHave you ever been denied a license?YesNoDenied a permit or privilege to operate a motor vehicleLicense Denied ExplainedHas any license, permit or privilege ever been suspended or revoked?YesNoLicense Denied ExplainedEMPLOYMENT RECORD Last 3 employersMost Recent Employer NameAddressDate From:* Date To: ------------------------------------NameAddressDate From: Date To: Reasons For Leaving: ------------------------------------NameAddressDate From: Date To: Reasons For Leaving:Conditions Applicants selected for interview will be required to submit the following documentation at the time of their interview: 5-year N & P print abstracts dated within 30 days of interview 5-year claims history As a condition of employment, all drivers are subject to random drug and alcohol testing In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Lotus Terminals Ltd.NameThis field is for validation purposes and should be left unchanged.
