SAFETY. STABILITY. SERVICE. THE LANDTRAN GROUP OF COMPANIES

Select Company: - Please Choose - Continental Cartage Inc.Det’on Cho Landtran Transport Ltd. Position Applied For: Position Type: Permanent   Temporary   First Name: Middle Name: Last Name: Date of Birth: Phone No:

Current Address

Street Address: City/Town: Province: Postal Code: How long have you lived at this address?

Other Address

If you have lived at any other addresses within the past 3 years, please list them below:

[ + Add Address ]

Driver Licenses

Please list all your current driver licenses below:

[ + Add License ]

Driving Experience

Please list all your applicable driving experience below:

[ + Add Experience ]

Accident Record

Please list any accidents on your record for the past 3 years or more:

[ + Add Accident ]

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?   Yes   No

B. Has any license, permit or privilege ever been suspended or revoked?   Yes   No

C. Do you have any disabilities that would restrict/impede your ability to perform the duties associated with the position?   Yes   No

Safety Violation Record

Please list any safety violations on your record for the past 5 years:

[ + Add Violation ]