Driver Reference Check
Previous Employee’s Name ALEXANDRU GHENCEA
First Contact Attempt
Name of Person Attempting Anita Nesairudayam
Attempt Type (Phone/Email) Email:
[email protected]Successful? (Yes/No)
Second Contact Attempt
Name of Person Attempting
Attempt Type (Phone/Email)
Successful? (Yes/No)
Second Contact Attempt
Name of Person Attempting
Attempt Type (Phone/Email)
Successful? (Yes/No)
Reference Information
Previous Employer 1
Previous Employer Name FOGZ LOGISTICS
Employment Dates
Start Date: End Date:
Type of Work the Employee Did
Driver
Dock
Stop
Office
Other (Please Specify):
4016 County Rd 23, Essex, ON N8M 2X 1
If Employed as a Driver, please indicate the type of equipment Driven
Tractor Trailer
Straight Truck
Flat Bed
Bus
Cargo Van
B-Train
Other (Please Specify):
If Employed as a Driver, what was their position in the company?
Owner Operator
Driver for Owner Operator
Company Single Driver
Company team Driver
City/Local Driver
Other (Please Specify):
Areas of Travel
Local
United States
Canada
Other (Please Specify):
Accidents
No Accidents on File
Accidents on File
Preventable Non-Preventable
At Fault
Yes No
If answered yes, please provide details regarding accidents:
4016 County Rd 23, Essex, ON N8M 2X 2
Tickets or Violations
No
Yes
If answered yes, please provide details with information regarding the tickets/violations
Were there any needs for Disciplinary Action?
No
Yes
If answered yes, please provide details
Reason for Departure from company
Resigned
Laid Off
Terminated
Would you rehire this person?
Yes
No
Upon Review
4016 County Rd 23, Essex, ON N8M 2X 3
Was this employee subject to D.O.T. Drug and Alcohol testing requirements?
Yes
No
If answered yes, please answer the following questions below (past 3 years of records)
Did the employee have alcohol tests with a result of 0.04 or higher? Yes / No
Has this person ever tested positive for controlled substances? Yes / No
Has the employer ever refused to be tested? Yes / No
Did the employee have other D.O.T. agency drug and alcohol testing regulations? Yes / No
Is answered yes to any of the above questions, did the employee complete the Return To Work
Process? Yes / No
Completed By
Signature
Date
4016 County Rd 23, Essex, ON N8M 2X 4
