Empoyment Application

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Type of Application*

Today's Date*

MM slash DD slash YYYY

What position are you applying to?*

Where did you hear about this position?*

YOUR INFORMATION

Applicant Name*

First Last

Email*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone*

Message Phone*

List your address of residency for the past 3 years:*

Address

City, State, Zip

How Long?

Add more rows (if needed).

Are you authorized to work in the United States?*

Yes

Are you at least 22 years of age?*

Yes

Have you worked for Fitz Towing or any of their affiliates before?*

Yes

Are you employed now?*

Yes

Are you able to pass a criminal background check?*

Yes

Is there any reason you might be unable to perform the functions of the job for which you have applied?*

Yes

QUALIFICATIONS AND LICENSES (IF APPLICABLE)

Driver's license state(s):

Driver's license #:

Driver's license type:

License expiration:

2nd license state(s):

2nd license #:

2nd license type:

2nd license expiration:

Any other licenses or permits pertinent to this job?

Have you ever been denied a license, permit or privilege to operate a motor vehicle?*

Yes

When?*

MM slash DD slash YYYY

Reason:*

Have you ever had a license, permit or privilege suspended or revoked?*

Yes

When?*

MM slash DD slash YYYY

Reason:*

DRIVING EXPERIENCE (IF APPLICABLE)

I have no professional driving experience

Class of equipment (Check all that apply):

Tractor and semi-trailer

Tractor - Two Trailers

Tractor - Three Trailers

Motor coach - School Bus

Straight Truck

Other

TRACTOR AND SEMI TRAILER

Start date:*

MM slash DD slash YYYY

End date:

MM slash DD slash YYYY

(Leave blank if current)

Type of Equipment:*

(Van, tank, flat, etc.)

Approx Number of Miles:*

TRACTOR - TWO TRAILERS

Start date:*

MM slash DD slash YYYY

End date:

MM slash DD slash YYYY

(Leave blank if current)

Type of Equipment:*

(Van, tank, flat, etc.)

Approx Number of Miles:*

TRACTOR - THREE TRAILERS

Start date:*

MM slash DD slash YYYY

End date:

MM slash DD slash YYYY

(Leave blank if current)

Type of Equipment:*

(Van, tank, flat, etc.)

Approx Number of Miles:*

MOTOR COACH - SCHOOL BUS

Start date:*

MM slash DD slash YYYY

End date:

MM slash DD slash YYYY

(Leave blank if current)

Type of Equipment:*

(Van, tank, flat, etc.)

Approx Number of Miles:*

STRAIGHT TRUCK

Start date:*

MM slash DD slash YYYY

End date:

MM slash DD slash YYYY

(Leave blank if current)

Type of Equipment:*

(Van, tank, flat, etc.)

Approx Number of Miles:*

OTHER

Start date:*

MM slash DD slash YYYY

End date:

MM slash DD slash YYYY

(Leave blank if current)

Type of Equipment:*

(Van, tank, flat, etc.)

Approx Number of Miles:

ACCIDENT RECORD (3 YEAR ABSTRACT IS REQUIRED FOR DRIVERS)

I have no professional driving experience

I have had no accidents in the last 3 years

List your accident of residency for the past 3 years:*

Date of accident:

Nature of accident:

Fatalities or injuries:

Type of citation issued:

Add more rows (if needed).

TRAFFIC CONVICTIONS AND FORFEITURES (PAST 3 YEARS, OTHER THAN PARKING VIOLATIONS)

I have had no traffic convictions or forfeitures in the last 3 years

List your accident of residency for the past 3 years:*

Date:

Location:

Charge:

Penalty:

EMPLOYMENT INFORMATION

List States operated in for the last 5 years (if applicable):*

Any special courses or training that will help you as a driver?*

Any trucking, transportation or other experience that will help you as a driver?*

Any special equipment or technical materials you have experience with?*

MOST RECENT EMPLOYER (IF APPLICABLE)

Employer name:*

(if no employment history, mark N/A on applicable fields)

Start date:*

MM slash DD slash YYYY

End Date:

MM slash DD slash YYYY

LEAVE BLANK IF CURRENT EMPLOYER

Address

Street Address Address Line 2 City State ZIP Code

Position*

Salary:*

Supervisor's name:*

Phone:*

Reason for leaving:*

Was your job designated as a safety - sensitive function in any DOT regulated mode subject to the drug and alcohol requirements of 9 CFR PART 40?*

Yes

N/A

Were you subject to the FMCSRs while employed?*

Yes

N/A

2ND MOST RECENT EMPLOYER (IF APPLICABLE)

Employer #2 Name:

Start date:

MM slash DD slash YYYY

End Date:

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State ZIP Code

Position

Salary:

Supervisor's name:

Phone:

Reason for leaving:

Was your job designated as a safety - sensitive function in any DOT regulated mode subject to the drug and alcohol requirements of 9 CFR PART 40?

Yes

N/A

Were you subject to the FMCSRs while employed?

Yes

N/A

3RD MOST RECENT EMPLOYER (IF APPLICABLE)

Employer #3 Name:

Start date:

MM slash DD slash YYYY

End Date:

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State ZIP Code

Position

Salary:

Supervisor's name:

Phone:

Reason for leaving:

Was your job designated as a safety - sensitive function in any DOT regulated mode subject to the drug and alcohol requirements of 9 CFR PART 40?*

Yes

N/A

Were you subject to the FMCSRs while employed?*

Yes

N/A

EDUCATION

Will there be a resume with this application?*

Yes

N/A

High School:

Location:

Graduated?*

Yes

N/A

Any special certificates or classes:

Any special awards or recognitions:

Languages spoken:

TO BE READ AND DIGITALLY INITIALED BY APPLICANT

Consent

I authorize Fitz Towing to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my employment.

In the event of employment:*

I understand that false or misleading information given in my application or interview(s) may result in discharge.

Consent*

I understand that I am required to abide by all rules, regulations and policies of Fitz Towing.*

Consent*

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) Will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e)*

Consent*

I understand that a background check will be obtained for employment purposes at Fitz Towing.*

As a condition of employment with Fitz Towing, if you are offered employment, are you willing to undergo a criminal background and employment reference check? Note - The existence of a criminal history will not automatically disqualify you from the job you are applying for. **

Yes

As part of the hiring process, applicants who receive an offer of employment will asked to submit to a screening test to detect the presence of drugs (marijuana, opiates, cocaine, amphetamines, phencyclidine (PCP)) and/or alcohol or their metabolites. Offers of employment are conditioned on a negative result. If you are asked to submit to a drug/alcohol test and you refuse to be tested, or you do not pass, Fitz Towing will revoke any offer of employment. All drug/alcohol tests will be conducted in accordance with applicable federal and state law and be done through urinalysis or oral swab. As a condition of employment with Fitz Towing, if you are offered employment, are you willing to submit to a drug screening test?*

Yes

I understand I have the right to:

Review information provided by previous employers.

Consent*

Have errors in the information corrected by previous employers and for previous employers to re-send the corrected information to Fitz Towing.*

Consent*

Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.*

Consent*

I acknowledge that me typing my initials is a proxy for my physical signature and verification that the above information is accurate and mine.*

Initials:*

Initial Date:*

MM slash DD slash YYYY

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Empoyment Application

YOUR INFORMATION

QUALIFICATIONS AND LICENSES (IF APPLICABLE)

DRIVING EXPERIENCE (IF APPLICABLE)

TRACTOR AND SEMI TRAILER

TRACTOR - TWO TRAILERS

TRACTOR - THREE TRAILERS

MOTOR COACH - SCHOOL BUS

STRAIGHT TRUCK

OTHER

ACCIDENT RECORD (3 YEAR ABSTRACT IS REQUIRED FOR DRIVERS)

TRAFFIC CONVICTIONS AND FORFEITURES (PAST 3 YEARS, OTHER THAN PARKING VIOLATIONS)

EMPLOYMENT INFORMATION

MOST RECENT EMPLOYER (IF APPLICABLE)

2ND MOST RECENT EMPLOYER (IF APPLICABLE)

3RD MOST RECENT EMPLOYER (IF APPLICABLE)

EDUCATION

TO BE READ AND DIGITALLY INITIALED BY APPLICANT

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