DIGNITY TRANSPORTATION INC.

We Turn Disability into Mobility

DRIVER APPLICATION

Date of Application

Personal Information

Last Name *

First Name *

Middle Name

Address *

Address 2

City *

Province *

Postal Code *

Resided less than 3 years? List previous addresses

Home Phone

Cell *

Email *

Emergency Contact

Relationship

Emergency Phone

Are You Presently employed? *

When are you available to start? *

Are there any physical limitations which may limit your ability to perform the job applied for? *

Referred By

Employment History (Last 5 Years)

All driver applicants to drive a commercial motor vehicle shall provide information on all employers during the preceding 5 years or until 3 years employment of driving has been accounted for. Please list all employers in reverse order, starting with the most recent.

Employer 1

Date From

Date To

Name of Company

Address

City

Province

Postal Code

Position Held

Salary/Wage

Contact Person

Position (Contact)

Phone Number

Type of Vehicle Driven

Reason for Leaving

Employer 2

Date From

Date To

Name of Company

Address

City

Province

Postal Code

Position Held

Salary/Wage

Contact Person

Position (Contact)

Phone Number

Type of Vehicle Driven

Reason for Leaving

Employer 3

Date From

Date To

Name of Company

Address

City

Province

Postal Code

Position Held

Salary/Wage

Contact Person

Position (Contact)

Phone Number

Type of Vehicle Driven

Reason for Leaving

Accidents & Infractions (Last 5 Years)

How many accident - free driving years do you currently have?

List any motor vehicle accidents you have been involved in during the past 5 years

Date	Nature of Accident	At Fault?	Injuries?	Fatalities?

Have you ever been convicted of a criminal offence in Canada or abroad?

Date	Nature of Infraction	Province	Penalty

License & Eligibility

Did you attend an accredited driving school in order to obtain your license? *

License Number *

Expiry Date *

Class *

Issuing Province *

Have you ever been denied a license, permit or privilege to operate a motor vehicle? *

Has any license, permit or privilege to drive ever been suspended or revoked? *

Position Applying For

Are you looking drive a wheelchair access vehicle owned by Dignity Transportation? *

Are you looking to drive a wheelchair accessible vehicle owned by you? *

Are you looking to drive a non emergency stretcher vehicle owned by Dignity Transportation? *

Are you looking to drive a non-emergency stretcher vehicle owned by you? *

Are you looking to be a crew member of a non emergency stretcher vehicle? *

Are you looking to do school runs for us on a part time bases with your own vehicle? *

Own Vehicle? *

Documents

Drivers License Image (Front)

Allowed: PDF, JPG, PNG

Drivers License Image (Back)

Allowed: PDF, JPG, PNG

Drivers Abstract

Allowed: PDF only

Resume/CVV

Allowed: PDF only

First Aid Certificate

Allowed: PDF only

Criminal History Document (Upload PDF)

Allowed: PDF only

Explanation/Notes (Criminal History)

I certify that I completed this application and that all information provided is true and complete to the best of my knowledge. I authorize Dignity Transportation Inc. to conduct any inquiries necessary to verify my personal, employment, financial, medical, or other relevant history for employment purposes, and I release all employers, schools, and individuals from liability for providing such information. I understand that any false or misleading information provided in my application or during the interview process may result in disqualification or termination, and if hired, I agree to follow all company rules and regulations, as permitted by law.