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Driver Application
Driver Application
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Fair Credit Reporting Act
Pursuant to the federal Fair Credit Reporting Act, I hereby authorize this company and its designated agents and representatives to conduct a comprehensive review of my background through any consumer report for employment. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.
I understand that I have the right to:
• Review information provided by previous employers. • Have errors in the information corrected by the previous employers and for those employers to re-send the corrected information to the prospective employer. • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer and I cannot agree on the accuracy of the information.
Signature
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Full Name
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Date
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MM slash DD slash YYYY
Applicant Information
Full Name
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First
Last
Phone
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Email
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Address
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Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
How many years of towing experience do you have?
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Please list any towing companies you have worked at previously:
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What is your weekly GROSS (before taxes and deductions) earnings goal?
*
Where do you see yourself 5 years from now?
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Compliance
Are you authorized to work in the United States?
*
If no, please contact hiring manager.
Yes
No
Have you had ANY accidents/crashes in the last 3 years?
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Yes
No
If yes, any citations or fatalities?
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Yes
No
Have you had ANY traffic violations in the last 3 years?
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Yes
No
If yes, please describe:
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During the previous three years, did you have any verified positive drug test(s)?
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If yes, please contact hiring manager.
Yes
No
During the previous three years, did you have any refusals to be tested?
*
If yes, please contact hiring manager.
Yes
No
During the previous three years, did you have any other violations of DOT regulated drug and alcohol testing requirements?
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If yes, please contact hiring manager.
Yes
No
Do you hold a DOT Medical Certificate?
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Yes
No
When does your DOT Medical Certificate expire?
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MM slash DD slash YYYY
Do you have any schedule restrictions?
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Yes
No
Are you available to work weekends?
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Yes
No
Are you available to work night shift?
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Yes
No
Are you available to work holidays?
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Yes
No
Please explain your schedule restrictions:
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Notification and Agreement
It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty and may led to termination of employment. It is agreed and understood that this Application in no way obligates the motor carrier to employ or hire the applicant. It is agreed and understood that if qualified and hired, I will be on a 90 days probationary period during which time I may be disqualified without recourse.
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
Signature
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Full Name
*
Date
*
MM slash DD slash YYYY
Confidential Information
Please provide social security number, date of birth, and age below.
We keep confidential information in a separate file for your protection.
Social Security #
*
Date of Birth
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Month
Day
Year
Age
*
Driver's License #
*
Driver's License State
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Driver’s License Expiration Date
*
Month
Day
Year
Comments
This field is for validation purposes and should be left unchanged.
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