| Please fill out this application as completely as possible in order to be considered. |
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| Last Name: |
First Name: |
Street Address: |
City: |
State: |
Zip: |
Home Phone:
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Alternate Phone:
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Work Phone:
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Social Security: |
Email Address |
Are you 18 years of age or older? Yes No |
Have you ever been convicted of a crime? Yes No - If yes, please explain.
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How were you referred to our company?
College
Advertising
Recruiter/Agency
Employee
Walk-in
Other
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Position Preference:
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Desired Salary: $ per (please specify hour, week or year) |
Schedule Desired:
Full Time
Part Time
Days
Evenings |
Number of hours per week:
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Are you able work overtime?
Yes
No |
What date are you able to start work?
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Are you able travel?
Yes
No |
| EDUCATION |
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Last year completed and where:
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List any certificates earned, or in progress, and/or any additional training programs not included in your formal education.
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List any professional affiliations to which you belong. (Please do not list activities which would indicate age, race, sex, color, creed, national origin, religion, marital status, or disability):
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Have you had any previous towing and recovery experience?
Yes
No |
Do you have any experience in dealing with customer needs, complaints, demands from previous jobs?
Yes
No - If yes, please explain.
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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
No |
Would you enjoy teaming with police personnel at highway accident scenes?
Yes
No |
Can you work in all weather conditions on the roadways?
Yes
No |
Do you have any automobile-mechanical knowledge or experience?
Yes
No - If yes, please explain.
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Do you see yourself enjoying any personal or professional growth with this work?
Yes
No - If yes, please explain.
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Do you have any physical or medical condition that will affect your ability to properly operate a tow vehicle and drive a tow vehicle for a full shift?
Yes
No - If yes, please explain.
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Do you have a commercial drivers license?
Yes
No - If yes, what type or class?
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Do you have any emergency roadside assistance experience?
Yes
No |
Have you had any EMT of Fire Department experience?
Yes
No |
Have you operated a wheel lift?
Yes
No |
A rollback?
Yes
No |
A tractor-trailer?
Yes
No |
A forklift?
Yes
No |
Have you operated any heavy equipment?
Yes
No |
Do you have any locksmith or lockout experience?
Yes
No |
Do you have any dispatching experience?
Yes
No |
Do you have any accounting or clerical experience?
Yes
No |
Do you have any telephone answering experience?
Yes
No |
| EMPLOYMENT HISTORY
List your current or most recent employment first. (please include work related internships, military and volunteer work)
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| Current employer: |
Dates of employment - From: To: |
May we contact this Employer?
Yes
No |
City: |
State: |
Phone: |
Supervisor's Name: |
Position Title: |
Reason for leaving:
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Salary: per
(specify hour, week, or year) |
| Previous Employer: |
Dates of employment - From: To: |
May we contact this Employer?
Yes
No |
City: |
State: |
Phone: |
Supervisor's Name: |
Position Title: |
Reason for leaving:
|
Salary: per
(specify hour, week, or year) |
| Previous Employer: |
Dates of employment - From: To: |
May we contact this Employer?
Yes
No |
City: |
State: |
Phone: |
Supervisor's Name: |
Position Title: |
Reason for leaving:
|
Salary: per
(specify hour, week, or year) |
| Previous Employer: |
Dates of employment - From: To: |
May we contact this Employer?
Yes
No |
City: |
State: |
Phone: |
Supervisor's Name: |
Position Title: |
Reason for leaving:
|
Salary: per
(specify hour, week, or year) |
| Previous Employer: |
Dates of employment - From: To: |
May we contact this Employer?
Yes
No |
City: |
State: |
Phone: |
Supervisor's Name: |
Position Title: |
Reason for leaving:
|
Salary: per
(specify hour, week, or year) |
Have you ever been bonded?
Yes
No - If yes, with which employers have you been bonded?
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| WORK REFERENCES |
Reference 1: |
Name: |
Title: |
| Company: |
| Phone: |
Professional relationship: |
Reference 2: |
Name: |
Title: |
| Company: |
| Phone: |
Professional relationship: |
Reference 3: |
Name: |
Title: |
| Company: |
| Phone: |
Professional relationship: |
Reference 4: |
Name: |
Title: |
| Company: |
| Phone: |
Professional relationship: |
| APPLICANT RELEASE
In connection with my application for employment (including contract for services), and as 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 from previous employers.
Further, I understand that Century, Inc. will be requesting information from various Federal, State and other agencies, that 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 of any agency contacted to furnish the above information and release all parties involved from liability and responsibility for doing so. I hereby consent to obtaining the above information by Century, Inc. 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 Century, Inc. has no specific term and may be terminated by the employee or company with or without notice. I acknowledge that Century, Inc. has not made any promises or representations that differ from those contained in this paragraph.
I understand that 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 Century, Inc. and I agree to release and 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 any subsequent employment with the company may be terminated.
Note: A motor carrier may require an applicant to provide information in addition to the information required by the federal Motor Carrier Safety Regulations.
As a condition of employment applicant will be required to submit to an approved drug test. Periodic physicals and random drug testing are also required. |
The following information is required by law enforcement agencies and other entities for identification purposes when checking records. It is confidential and will not be used for any other purpose. |
Full Name:
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Sex:
male
female
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Write other names you have used.
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Date of Birth:
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Social Security:
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Current Driver's License Number:
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Issuing State:
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Previous Driver's License Number:
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Issuing State:
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Street:
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City:
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State:
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Zip:
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Country:
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| From:
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To:
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RESIDENTIAL HISTORY (please list for the last seven years) |
Street:
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City:
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| State:
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Zip:
| Country:
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Street:
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City:
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| State:
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Zip:
| Country:
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Street:
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City:
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| State:
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Zip:
| Country:
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Street:
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City:
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| State:
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Zip:
| Country:
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List any Traffic Convictions and Forfeitures for the Past 3 years. (other than Parking violations) List Location, Date, Charge, and Penalty.
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Have you ever been denied a license, permit, or privilege of driving?
yes
no
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Has any license, permit, or privilege been suspended or revoked?
yes
no |
If the answer to either of the previous questions is yes, a statement providing explanation is mandatory.
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Are you able to provide transportation to and from work?
yes
no |
Have you ever had a workman's compensation claim?
yes
no |
| Century, Inc. is an equal opportunity employer.
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