All driver applicants must Provide the following: * Current drivers license abstract Date: Last Name: First Name: Middle Initial Address: City: Province: Postal Code: Home Phone: Cell Phone: Pager: S.I.N. Birthdate: D.L.# Height: Weight: Marital Status: How Long at current address? Do you Rent or Own Rent Own Previous Address (If less than 3 years) Personal References: Name: Address: Phone #: Name: Address: Phone #: List any friends or relatives working for Big Rig Towing: First Name: Last Name: Address: Phone #: First Name: Last Name: Address: Phone #: Contact Person In Case Of Emergency: First Name: Last Name: Address: City: Province: Postal Code: Phone # Relation To You: Do you have any physical restrictions or limitations: Yes No If Yes, Please explain: Have you had a major illness in the past 5 years: Yes No If yes, please explain: Have you received compensation for injuries: Yes No If yes, please explain: Are you physically capable of heavy manual work: Yes No IF no, please explain: List and describe all accidents in the past 3 years: Has your license ever been suspended or restricted: Yes No If yes, please explain: Have you ever been convicted for Driving Under the Influence of alcohol and/or drugs: Yes No If yes, please explain: Have you ever been refused a bond: Yes No If yes, please explain: Can you cross the U.S. border: Yes No If no, please explain: Educational Background: School Name: Address: City: Province: Dates Attended: Highest Grade Completed: Sr. High School Name: Address: City: Dates Attended: Highest Grade Completed: Driving School Name: Address: City: Province: Date Completed: Other School: Address: City: Province: Dates Attended: Course Completed: Please list any other courses taken (ie: self improvement, "V" endorsement, HazMat courses, etc.) Employment Background Name: Phone: Address: City: Province: Postal Code: Position: Contact: From: To: Reason For Leaving: Name: Phone: Address: City: Province: Postal Code: Position: Contact: From: To: Reason For Leaving: Name: Phone: Address: Position: Contact: From: To: Reason For Leaving: May we contact these employers? Yes No

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