Sub-Contractor Application


Applicant Information


Date (YYYY-MM-DD)

Name (Surname, Given, Initials) S.I.N Birthdate (YYYY-MM-DD)
Address Prov. Postal Code
Phone Cell Email

Name of Incorporation:

Addresses for previous 3 years (if different from above):

Address Prov. Postal Code

Contract position applied for:

Local YesNo Long Haul YesNo USA? YesNo
Desired Shift: A.M.P.M. Weekends? YesNo Able to Hand Bomb? YesNo
AZ YesNo # of Years Experience
DZ YesNo # of Years Experience
Other License
Driver's License Number: Driver's License Expiry Date:

Has your license ever been suspended or revoked? YesNo
Have you ever been denied a license, permit or privilege to operate a motor vehicle? YesNo

If the answer to either of the above two statements is YES, attach statement giving details.

Do you have the legal right to work in Canada? YesNo

Do you have any limitations, medical conditions or chronic ailments that will affect your performance as a contracted commercial driver? YesNo
If YES, describe:

Are you currently employed/contracted? YesNo
Emergency Contact Name Phone
Relationship

How did you hear about Inter-Link Contract Services?
Newspaper: Which one? Magazine: Which one?
Personal Referral Other


For Inter-Link/United Services to complete:

Shift Discussed: AM / PM

Start Time Discussed:

Driver Initial:


EMPLOYMENT HISTORY

All applicants to drive commercial vehicles in Canada and the United States must provide the following information on all previous employers during the preceding 3 years. ***List the truck lines, not the Owner Operator you drove for***

DRIVER NAME:
License Number:

Company Name From To
Address Postal Code
Position Held Salary/Wage
Contact Person Contact Phone Number
Reason for Leaving
Type of Equipment Driven
Type of Trailer
Type of Freight Hauled
Areas You Drove In
Commercial motor vehicle violations or accidents while with this company? YesNo Enrolled in drug testing program?
YesNo


DRIVERS, PLEASE DO NOT FILL IN. FOR FORMER EMPLOYERS ONLY TO COMPLETE:

Please provide a rating (Good/Fair/Poor) in the following areas

Quality of Paperwork: GoodFairPoor
Backing Skills: GoodFairPoor
Customer Relations:GoodFairPoor
Co-Worker Relations: GoodFairPoor
Timeliness:GoodFairPoor
Safety & Compliance:GoodFairPoor
Trip Planning:GoodFairPoor
Hours of Service(Logs):GoodFairPoor
Attitude/Appearance:GoodFairPoor
Equipment Handling:GoodFairPoor
Any Accidents/Incidents? YesNo If yes please describe:
Would you rehire: YesNo Notice Given: YesNo
WSIB Claims: YesNo
Time Lost: YesNo


APPLICANT AUTHORIZATION:

I authorize the company to release all my employment information to Interlink/United Services for the purposes of investigation for a driver position.

Driver Sign:
By ticking this box you authorize Interlink/United Services to contact your previous employer

Date:


EMPLOYMENT HISTORY

All applicants to drive commercial vehicles in Canada and the United States must provide the following information on all previous employers during the preceding 3 years. ***List the truck lines, not the Owner Operator you drove for***

DRIVER NAME:
License Number:

Company Name From To
Address Postal Code
Position Held Salary/Wage
Contact Person Contact Phone Number
Reason for Leaving
Type of Equipment Driven
Type of Trailer
Type of Freight Hauled
Areas You Drove In
Commercial motor vehicle violations or accidents while with this company? YesNo Enrolled in drug testing program?
YesNo


DRIVERS, PLEASE DO NOT FILL IN. FOR FORMER EMPLOYERS ONLY TO COMPLETE:

Please provide a rating (Good/Fair/Poor) in the following areas

Quality of Paperwork: GoodFairPoor
Backing Skills: GoodFairPoor
Customer Relations:GoodFairPoor
Co-Worker Relations: GoodFairPoor
Timeliness:GoodFairPoor
Safety & Compliance:GoodFairPoor
Trip Planning:GoodFairPoor
Hours of Service(Logs):GoodFairPoor
Attitude/Appearance:GoodFairPoor
Equipment Handling:GoodFairPoor
Any Accidents/Incidents? YesNo If yes please describe:
Would you rehire: YesNo Notice Given: YesNo
WSIB Claims: YesNo
Time Lost: YesNo


APPLICANT AUTHORIZATION:

I authorize the company to release all my employment information to Interlink/United Services for the purposes of investigation for a driver position.

Driver Sign:
By ticking this box you authorize Interlink/United Services to contact your previous employer

Date:


EDUCATION

Grade/Secondary School Course of Study Type of Certificate or Diploma Obtained
Business, Trade or Technical School Course of Study Program Length (yrs) 1234 License, Certificate or Diploma Awarded


EXPERIENCE AND QUALIFICATIONS – DRIVER

Drivers License Province/State License No. Type Exp. Date (YYYY-MM-DD)


DRIVING EXPERIENCE

Class of Equipment Type of Equipment Van, Tank, Flat, Etc. (Please Specify) From (YYYY-MM-DD) To (YYYY-MM-DD) Approx No. of Miles (Total)
Straight Truck
Tractor & Semi-Trailer
Tractor - Two Trailers Type (A,B,C)
Other

Provinces, States, or Territories operated in for the last five years:

Special Courses or Training that will help you as a driver:

Which safe driving awards do you hold and from whom?


EXPERIENCE AND QUALIFICATIONS – OTHER

Show any trucking, transportation or other experience that may help in your work for our company.

List courses and training other than shown elsewhere in this application.

List special equipment or technical materials you can work with (other than those already shown).

To avoid duplication and/or embarrassment, please list the companies to which you have applied in the past 3 months:


Office Use Only:

Interview Notes: List All Training Provided:

To be Discussed with Driver: Initial
Workplace Safety/Drug Testing Policies/Procedures / Payment
Payroll – handling /rates/pay periods/contact
Terms of Placement - temp employment/duration


ACCIDENT REPORT INFORMATION

Driver Instructions : Complete information for all reportable accidents in which you were involved during the past 5 years. List the oldest reportable accidents first. Please number the accidents (1, 2, etc) if reporting multiple accidents (Attach sheet if more space is needed).

Date Type of Vehicle Nature of Accident (Head-On, Rearend, Upset, etc) Chargeable/Non-Chargeable Fatalaties Injuries

DRIVER’S INSTRUCTIONS:

Provide data for all traffic offences and criminal driving offences for which you were convicted during the past five years. This information is to be updated at the time of each conviction.

Location Date (YYYY-MM-DD) Charge Penalty

I certify that the above information is accurate and true.

Driver Sign:
By ticking this box you authorize Interlink/United Services to contact your previous employer

Date:

Accidents, Incidents, Spills, Vehicle Damage Report and Procedures

1. ALL ACCIDENTS, INCIDENTS, TICKETS, SPILLS AND VEHICLE DAMAGE MUST BE REPORTED AT THE TIME OF OCCURANCE TO DISPATCH, AND INTER-LINK.
2. Immediate reporting gives us the chance to send Safety & Compliance to the scene to take control and minimize costs.
3. If this is a motor vehicle accident involving yourself and other vehicles on the road, please notify the police (911) as well.
4. After verbal notification, the following will be required :

a. Time, date and location of the accident or incident

b. Unit numbers (Tractor, trailer) and other vehicle information

c. Other parties’ information : license, insurance, plate number, vehicle make, year, description of damage and driver’s personal information

d. Witness (if any) information

e. Police reports / information

f. Written statement that describes the events leading up to the accident / incident

g. A drawing indication position of vehicles is very helpful in the investigation

5. While working for Inter-Link or United Services you are doing so as a sub- contractor and not as an employee. As such, your pay will not have any of the following deductions: income tax, EI, CPP, or EHT. You will also not be paid the following: holiday pay and statutory holidays.
6. As a sub-contractor you reserve the right to accept or refuse any shift assigned to you.
7. No passengers under any circumstances. This includes: wives, girlfriends, husbands, boyfriends, pets, friends, children, acquaintances, hitchhikers or anyone else unless instructed otherwise by Inter-Link or the customer you’re driving for.

FAILURE TO REPORT, OR LATE REPORTING OF ANY: ACCIDENT, INCIDENT, SPILL, TICKETS, OR VEHICLE DAMAGE WILL RESULT IN A REVIEW OF YOUR CONTRACTUAL STATUS WITH INTER-LINK OR UNITED SERVICES.

TO BE READ AND SIGNED BY SUB- CONTRACTOR/APPLICANT

This certifies that this application was completed by me, and that all entries on it, and information in it are true and complete to the best of my knowledge. I authorize Interlink and United Contract Services to make such investigations and inquiries of my personal employment/sub-contracting history, CVOR, Driver Abstract, criminal record search, medical history, drug results from previous employers or their consortium and other related matters as may be necessary in arriving at an employment decision. If contracted by Inter-Link/United Services, this authorization shall remain on file and shall serve as on-going authorization to re-check driving abstracts or reports as deemed necessary at any time throughout my contract period. I authorize Inter-Link and United Contract Services to deduct the associated fees for updating or testing and/or any other fees or fines that I have incurred. I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. I understand that false or misleading information given in my application or interview(s) may result in the termination of my contract. Furthermore, I understand that Inter-Link and United may keep any information on file including driving abstracts and work performance as related to my contract period and make it available to any second party including Inter-Link and United clients. I also understand that I am required to abide by all rules, regulations and Health and Safety policies of Inter-Link and United and operate in compliance with Federal and Provincial Laws. I have been provided and read the Driver Information package and also have current Transportation of Dangerous Goods training. For purposes of gathering information, I agree to supply the information which may be required by law enforcement agencies and other entities for positive identification purposes and/or proof of training when checking records. It is confidential and will not be used for any other purpose. I also understand that I am financially responsible for any damages that I cause to equipment and/or property resulting from my actions, as well as any fines I incur as a result of my actions. I realize that I am not an employee of Inter-Link or United Services. I am therefore not entitled to vacation pay, statutory holiday pay, or any other type of employee benefits. My pay will not include EI, CPP and will not have income tax deducted.

Driver Sign:[accceptance* driversignfinal]
By ticking this box you authorize Interlink/United Services to contact your previous employer

Date: