EMPLOYMENT

Towing Recovery Specialist Recruitment Application

The company identified in this application is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religion, marital status, sexual orientation, political belief or disability.

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity with three (3) days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

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Name:

Date:

Date of Birth:

Sex:

Male

Female

Issuing State of Driver' License:

Do you have a commercial driver's license?

Yes

If yes, what type?

Home Addresses:

For the last 7 years; list most current first

Street

City

State

Zip

From:

To:

Street

City

State

Zip

From:

To:

Personal Data:

Personal Data:

First Name:

Middle:

Last:

Street Address:

City:

State:

Zip Code:

Home Telephone Number:

Today’s Date:

Daytime phone number at which we may contact you :

Are you 18 years of age or older?

Yes

Have you ever been convicted of a crime?

Yes

If “yes”, please explain:

How were you referred to our company?

Position Preferences:

Salary Desired:

Schedule desired:

Full Time

Part Time

Days

Evenings

# of hours per week:

Could you work overtime?

Yes

What date could you start?

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Education:

Education:

High School:

Did you receive a diploma?

Yes

Did you receive a GED?

Yes

College:

School Name:

City:

State:

Degree or # of years completed:

Major or Subject:

GPA:

List any certificates earned or in progress, and/or any additional training programs not included in your formal education.

Do you have any experience dealing with customer needs, complaints, demands from previous jobs?

Yes

If yes, please explain:

Some of our positions require on-call status to handle emergency service dispatches during night hours. Would you be interested in periodically being on-call from your home?

Yes

Do you think you would enjoy teaming with police personnel at highway accident scenes?

Yes

Do you think you can work in all weather conditions on the roadways?

Yes

Do you have any automobile-mechanical knowledge or experience?

Yes

Explain:

Do you have any emergency road service experience?

Yes

Have you ever had any EMT or Fire Department experience?

Yes

Have you ever operated a wheel lift?

Yes

Have you ever operated a roll-back?

Yes

Have you ever operated a tractor trailer?

Yes

Have you ever operated a forklift

Yes

Have you ever operated any heavy equipment?

Blank Space

Previous Employment:

Previous Employment:

List your current or most recent employment first. Include work related internships, military and volunteer work.

1st Employer:

Dates of Employment From:

Dates of Employment To:

May we contact your employer:

Yes

Previous/Current employer:

City:

State:

Phone No:

Supervisor’s Name:

Position Title:

Reason for Leaving:

Salary:

Was this position covered by the FMCSR or DOT?

Yes

Was this position designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49CFR part 40?

Yes

Blank Space

2nd Employer:

Dates of Employment From:

Dates of Employment To:

May we contact your employer:

Yes

Previous/Current employer:

City:

State:

Phone No:

Supervisor’s Name:

Position Title:

Reason for Leaving:

Salary:

Was this position covered by the FMCSR or DOT?

Yes

Was this position designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49CFR part 40?

Yes

Blank Space

3rd Employer:

Dates of Employment From:

Dates of Employment To:

May we contact your employer:

Yes

Previous/Current employer:

City:

State:

Phone No:

Supervisor’s Name:

Position Title:

Reason for Leaving:

Salary:

Was this position covered by the FMCSR or DOT?

Yes

Was this position designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49CFR part 40?

Blank Space

4th Employer:

Dates of Employment From:

Dates of Employment To:

May we contact your employer:

Yes

Previous/Current employer:

City:

State:

Phone No:

Supervisor’s Name:

Position Title:

Reason for Leaving:

Salary:

Was this position covered by the FMCSR or DOT?

Yes

Was this position designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49CFR part 40?

Yes

List in order of most recent employer

List in order of most recent employer, MUST HAVE LAST FIVE-YEAR HISTORY

Blank Space

Work References

Work References

1st References:

Name:

Title:

Company:

Phone No:

Blank Space

2nd References:

Name:

Title:

Company:

Phone No:

Blank Space

3rd References:

Name:

Title:

Company:

Phone No:

Have you had accident/s in the last 3 years?

Yes

If yes describe. Please provide details

Do you currently have any Driver or Safety Certifications?

Yes

If yes describe:

Any Gaps in Employment Must Be Explained. Include Month and year

Free Text

In connection with my application for employment (including contract for services) and as a condition of continuing employment, I understand that investigative background inquiries are to be made on me including consumer credit, criminal convictions, motor vehicle, and other reports. These reports will include information as to my character, work habits, performance, education, and experience along with reasons for termination of employment from previous employers. Further I understand that the company will be requesting information from various federal, state, and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences as well as claims involving me in the files of insurance companies.

I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. I hereby consent to obtaining the above information by (company) and/or any of their agents. This authorization and consent shall be valid in original, fax, or copy form.

All hiring and employment at this towing company is at will. I understand this application is not an employment contract, nor can it be used to create one. Employment by (company) has no specific term and may be terminated by the employee or (company) with or without notice. I acknowledge that (company) has not made any promises or representations that differ from those contained in this paragraph.

I understand I must provide satisfactory documents to establish my identity and right to work in the United States, if I am offered a position with this company, and that failure to provide this evidence will result in the termination of my employment.

I release and agree to hold harmless any individual, company, business institution or government agency from all liability with regard to furnishing information to this company I agree to release hold harmless from all liability with respect to the receipt of such information.

I certify that the information I have furnished on this application form is true and complete. I understand that if any misrepresentation has been made by me verbally or in writing, any offer of employment made to me may be withdrawn or my subsequent employment with the company may be terminated.

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CONTACT INFO

3828 Christoval Rd

San Angelo, TX 76904

(325) 653-1793