ELK Logistic Inc.

Nature of Accident(Rear End, Wildlife etc.)

Province Occured In

Preventable

Non-Preventable

ELK LOGISTIC INC.

Personal Information

Title

Last Name

First Name

Middle Name

Email ID

Date of Birth

Phone Number

Gender / Sex

Male

Female

Home Address

Address 2

City

Province

Postal Code

Same as above:

Mailing Address

Address 2

City

Province

Postal Code

Home Phone

Cell Phone

Social Insurance Number(optional)

Driver License

Province

Driver License Expiry Date

How many demerit points on your current driving record?

Have you received more than 2 moving violations during the last 12 months?

Yes

How long have you held a Class 1 driver's license?

Are you legally entitled to work in Canada?

Do you have a Criminal Record?

Yes

Education

Highest Level Attained:

Name of last school or institution:

Professional Driving Course Attended(if any):

Driving History
(Click on the edit button to enter the details)

Traffic Convictions & Forfeitures(OTHER THAN PARKING VIOLATIONS) For The Past 3 Years
(Click on the edit button to enter the details)

Are you able to obtain border crossing clearance to enter into U.S.A.?

Yes

if No, please explain

Do you currently have a valid Passport?

Yes

Do you currently have a valid FAST card?

Yes

Are you able to be away from home for extended periods of time?

Yes

If yes, please specify length of time away:
2-5 Days 5-10 Days 10-14 Days

Do you have any specific requirements for days off, family needs?

Please record your available starting and ending time each day. If available at any time please state “Any” (Click on the edit button to enter the details)

Employee Availablity

Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday

Our various driving positions all have bona fide occupational requirements for physical strength and agility. Are you able to perform the basic duties of the position? (climbing, bending, lifting tarps, working with product line hoses)

Yes

Explain:

As part of our safety program and those required by our customers we have protective equipment requirements (hard hats, full body harness for fall arrest, respirators etc.), please indicate any accommodation you would require so we can assess the best job fit for you

As part of our driver hiring process and safety program we require that all Company Drivers, Owner Operators and Owner Operator Drivers be sent for Pre-Employment Drug Testing, Medical and Fitness Testing. Are you willing to participate in our Drug & Alcohol policy that includes pre-employment and random drug testing?

Yes

Employement History For Past 5-7 Years
Begin with your present / current employer and work backwards in order, listing all of your employers, driving school and other training programs, periods of military service, self-employment and unemployment for at least 5 -7 years. All time MUSTbe accounted for. Should more space be required, please attach to application form.

May we contact your present employer to verify your work record?

Yes

Period of unemployment 1 (if any) Date: From (month/year) To (month/year)

Period of Employement 1:

Date of Employment 1 From : To :

Postion Held:

Employer:

Supervisor Name:

Address:

Phone:

Fax:

Average Monthly Earnings: $

Type of Trailer Pulled:

Reason For Leaving:

Period of Employement 2:

Date of Employment 2 From : To :

Postion Held:

Employer:

Supervisor Name:

Address:

Phone:

Fax:

Average Monthly Earnings: $

Type of Trailer Pulled:

Reason For Leaving:

Period of Employement 3:

Date of Employment 3 From : To :

Postion Held:

Employer:

Supervisor Name:

Address:

Phone:

Fax:

Average Monthly Earnings: $

Type of Trailer Pulled:

Reason For Leaving:

Owner Operator Credit Application

Address:
277 Cartesian GateWinnipeg, MB, R2P 1W2Ph: (204)-914-6414Email: info@elklogistic.com

Truck Year info:

Truck Make:

Truck Model:

Serial Number:

Color:

Day Cab: Sleeper Bunk

Personal Information

Applicants First Name

Initial

Last Name

Number of Dependents

Birth Date

SIN

Spouse First Name

Initial

Last Name

Birth Date

SIN

Nearest Relative Name

City

Province

Phone

Registered Business Name (If Applicable)

Address Information

Present Address(Street No & Name)

City

Province

Postal Code

How Long?(years/months)

Home Telephone (with area code)

Own Rent

Former Address (if less than 2 years at present)

City

Province

Bank Information

Financial Institution Name

Address

Phone

Nature of Dealing

Contact Name

Other Creditor Information

Financial Institution Name

Address

Phone

Nature of Dealing

Contact Name

Have you filed bankruptcy? (last 6 yrs) Yes No

Any Previous Repossession? Yes No

I, the undersigned, confirm that I am current with my Canada Revenue and GST filing Yes No
GST Reg.

The undersigned hereby affirms that the information provided herein is in all respects true, accurate and complete and is furnished with the intent that is to be relied upon by Kleysen Group Ltdin extending credit to the applicant. I/We consent to Kleysen Group Ltd, or its associated corporations to conduct, or cause to be conducted, a credit investigation on a continuing basis to substantiate a line of credit.

Owner Opearator Truck Information

Owner Operator Name:

Home Terminal:

Division Apply For:
L/H Flatdeck AB Reg Flatdeck Bulk Intermodal