Automotive Division Application Form

SECTION 1: APPLICANT INFORMATION

Mailing Address

Emergency Contact

Current Driver License Info:

Local 155 does not advertise or solicit for referral:

SECTION 2: WORK HISTORY

(In chronologic order, starting with most recent)

SECTION 3: AUTOMOTIVE DIVISION QUESTIONS

Did you obtain your qualifications because it was required by Local 155?

YesNo

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

YesNo

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

YesNo

Has your license been clear of infractions for the last two years?

YesNo

How many years have you had your current class of commercial driver’s license?

years

If applicable, previous classes and number of years?

Approximately how many kilometers have you driven standard transmission?

I acknowledge I DO NOT have the restriction/endorsement 51: Automatic Transmission Only (on Drivers National Abstract)

YesNo

Have you ever had an accident in which a vehicle needed to be towed from a scene?

YesNo

Have you ever had an accident in which a person involved was removed from the scene by an

ambulance?

YesNo

Have you ever had an accident in which a fatality occurred as a result of the accident?

YesNo

SECTION 4: AUTOMOTIVE DIVISION REQUIREMENTS – DOCUMENT UPLOAD

A valid copy of all requirements must be submitted with your application.

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