			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
*****************************************************************************************
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
Destination 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.
	Do you have a Criminal Record now? Yes No Not Answered
	Have you ever had a Criminal Record? Yes No Not Answered
	Have you ever been arrested for possession of drugs of any kind? Yes No Not Answered
*****************************************************************************************
Driving Record
(1)	Has your license ever been suspended? Yes No Not Answered
	If Yes, when?		What for?
	For How Long?
(2)	Have you ever been charged with impaired drivng? Yes No Not Answered
	If Yes, when?
(3)	Have you ever been charged with careless drivng? Yes No Not Answered
	If Yes, when?
(4)	Have you had any speeding tickets during the last 3 years? Yes No Not Answered
	If Yes, how many?
(5)	Are there any demerit points against your license at present? Yes No Not Answered
	If Yes, how many?		What did you lose them for?
(6)	Are there any unpaid fines outstanding against you at present? Yes No Not Answered