Class 4 Driver Application Form

Personal Information

Name

First Name

Last Name

Date of Birth (DD/MM/YYYY):

Phone

Address

City

State/Province

Zip/Postal

Country

Driver's License Information

Class of Driver's License:

License Number:

Province of Issue:

Expiry Date (DD/MM/YYYY):

Any driving restrictions?

Yes

If yes, please specify:

Employment History (Last 3 Years)

Employer Name:

First Name

Last Name

Position Held:

Dates of Employment:

From

Reason for Leaving:

Contact Number:

Education and Training

Highest Level of Education Completed:

Relevant Certifications or Training (e.g., Defensive Driving, First Aid):

Education and Training

Do you meet the medical standards required for Class 4 drivers in Alberta?

Yes

Attach a recent medical certificate

Maximum file size: 10MB

Criminal Record Check

Are you willing to provide a criminal record check?

Yes

References

Name:

First Name

Last Name

Relationship:

Phone Number:

8. Declaration

I certify that the information provided is true and complete to the best of my knowledge. I understand that providing false information may result in disqualification or termination.

Signature:

Date:

For file upload and download buttons, if you are using a website or digital form platform, you can typically add:

Attach Medical Certificate

Maximum file size: 10MB

If you want help creating a digital form with these features, please specify the platform (e.g., Google Forms, Microsoft Forms, custom website).

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