CANADA’S OLDEST AUTO DELIVERY SYSTEM ESTABLISHED 1959
  5803 YONGE STREET - SUITE 101
ONLINE DRIVER APPLICATION FORM

WILLOWDALE, ONTARIO M2M 3V5

(This is not an Application for Employment)

TELEPHONE (416) 225-7754

This Application requires a valid license and proof thereof

FAX (416) 225-8790

* INDICATES A REQUIRED FIELD.

 
(Enter N/A if Not Applicable)
Present Date
Date Leaving (City)
Your Email
*Destination (City)
Province
Depart From (City)
Last Name
First Name
*Permanent Address Bldg # Apt #
*City
*Province/State
Postal/Zip Code
*Home Phone
*Cell Phone
*Business Phone
*****************************************************************************************
Name of Person accompanying driver (One passenger only)
*Name
*Address
Bldg # Apt #
*City
*Province/State
Postal/Zip Code
*Home Phone
*Cell Phone
Passenger Driving License Information
*License No .
*Expires
Province
*Driving Experience in Years
*DOB
*****************************************************************************************
Reference information
1.
Occupation
Phone
2.
Occupation
Phone
3.
Occupation
Phone
*****************************************************************************************
The following information is required for identification purposes only.
Age
Date of Birth
Weight
Height
Eye Colour
Glasses
Sex
Marital Status
Hair Colour
*****************************************************************************************
Spouse Contact Information
*Last Name
*First Name
*Permanent Address Bldg # Apt #
*City
*Province/State
Postal/Zip Code
*Home Phone
*Cell Phone
*Business Phone
*****************************************************************************************
Next of Kin Contact Information
*Last Name
*First Name
*Relationship
*Address
Bldg # Apt #
*City
*Province/State
Postal/Zip Code
*Home Phone
*Cell Phone
*Business Phone
*****************************************************************************************
Driving License Information
License No.
Expires
Province
Driving Experience in Years
Cash on Hand after deposit
Reason for trip
Destination Address
City
Province/State
Postal/Zip Code
Phone
Cell Phone
*****************************************************************************************
Employer Information
Employer Name
Address
City
Province/State
Postal/Zip Code
Business Phone
*****************************************************************************************
The following is required for proper border crossing documentation
Nationality
Place of Birth
Type of vehicle most familiar with

Please note that under section 24a(11) of the U.S. Immigration Act, it is illegal for a person to enter the States with a drug conviction, unless that person applies for a waiver.

Possession of the smallest amount of drugs or drug accessories will result in serious charges levied by the U.S. Customs - possible imprisonment - certain heavy fines and seizure of your possessions and the car.

 

No

  No
*****************************************************************************************
Driving Record
*(1)
Has your license ever been suspended? No
 
If Yes, when?
  What for?
 
For How Long?
   
*(2)
Have you ever been charged with impaired drivng? No
 
If Yes, when?
 
*(3)
Have you ever been charged with careless drivng? No
 
If Yes, when?
   
*(4)
Have you had any speeding tickets during the last 3 years? No
 
If Yes, how many?
   
*(5)
Are there any demerit points against your license at present? No
 
If Yes, how many?
  What did you lose them for?
*(6)
Are there any unpaid fines outstanding against you at present? No