Application for Employment

Social Security Number:
First Name:
Last Name:
Middle Name:
Address
	City: State: Zip:
Phone:
Are you at least 18 years old? Yes No
Are you legally qualified to work in the U.S. ? Yes No
Have you ever been convicted of a felony? Yes No
Position applied for:	Tow Truck Driver Mechanic
	Dispatch Operator Manager
	Other:
Do you have any physical disabilities which would prevent you from performing this job? Yes No

EDUCATION

List below all schools attended

Level	School (Name,Location)	From (Month/Year)	From (Month/Year)	Last Year Completed	Diploma/Degree Earned
Elementary
High School
College
Other

We are an Equal Opportunity employer. In accordance with federal law, we do not
discriminate on the basis of race, color, religion, sex, age, or national origin.

EMPLOYMENT HISTORY

List below all present and past employment (including military), most recent first.

Employer Company (Name, Address, Phone)	From (Month/ Year)	To (Month/ Year)	Position & Job Duties	Wage per Hour	Name of Super- visor	Reason for Leaving
Name: Address: Phone:
Name: Address: Phone:
Name: Address: Phone:
Name: Address: Phone:

WORK-RELATED EXPERIENCE

heck all types of tow truck equipment you can operate.

Tow Truck Sling Dollies Jumper Packs

Wheel Lift Flat Bed Radio

CHARACTER REFERENCES

List three persons (other than former employers and relatives) who have known you
at least three years.

Name	Address	Phone	Known how long?

This digital signature verifies that I authorize your investigation of all information contained in this application.

Name: Date: