EmailMe Form - Southwest Towing, Inc.

Available Job Positions: Dodge City, KS *

Tow Truck Operator (Part-Time): Flexible Hours

Tow Truck Operator (Full-Time): 40+ Weekly Hours

Extra Laborer/Shop (Full-Time): 40+ Weekly Hours

Not Applying for this location

Available Job Positions: Garden City, KS *

Tow Truck Operator (Part-Time): Flexible Hours

Tow Truck Operator (Full-Time): 40+ Weekly Hours

Extra Laborer/Shop (Full-Time): 40+ Weekly Hours

Not Applying for this location

Applicant Information:

Full Name: *

First MI Last

Current Address: *

Street Address City State / Province / Region Postal / Zip Code

Phone: *

### - ### - ####

Will be used for possible follow-up interview

Email: *

Will be used for our communication purposes only

Date of Birth: *

MM / DD / YYYY

Are You Legally Eligible To Work In The United States? *

Yes

No

According to USCIS Form I-9 (IRCA Regulations)

What Date Are You Available To Start Work? *

MM / DD / YYYY

Select your desired start date

Education Level: *

Diploma Equivalent

High School Diploma

College or Tech School Degree

Select your highest Level of Achievement

Qualifications: Skills, Training, Awards

Detail Your Employment History For The Past 3 Years:

- Current employer information (if applicable) will be filled out at the end of this form.
- If you have been employed with your current employer for 3 years, skip this section.
- Start with the most recent past employer in "Past Employer #1" box.
- Then continue in reverse date order.

Past Employer #1

Street Address City State / Province / Region Postal / Zip Code Country / Region

Start Date:

MM / DD / YYYY

End Date:

MM / DD / YYYY

_____________________________________________________________________________

Past Employer #2

Street Address City State / Province / Region Postal / Zip Code Country / Region

Start Date:

MM / DD / YYYY

End Date:

MM / DD / YYYY

_____________________________________________________________________________

Past Employer #3

Street Address City State / Province / Region Postal / Zip Code Country / Region

Start Date:

MM / DD / YYYY

End Date:

MM / DD / YYYY

_____________________________________________________________________________

How Many Years of Experience Do You Have Operating A Tow Truck? *

Light / Medium / Heavy

How Many Years of Licensed Experience Do You Have Operating A CMV? *

Commercial Motor Vehicle

Please Explain Job Experience Below:

Do You Currently Have a Valid Drivers License? *

Yes

No

In Which State is it Currently Issued?

Is Your License a Commercial Drivers License (CDL)? *

Yes

No

In What Year Was Your CDL First Issued?

Required if answered "Yes" above

Drivers License Number:

CDL Number must be included with ALL Tow Truck Operator applications * * *

Pursuant to FMCSA 49 CFR 391.23(a), 391.23(e), and 49 CFR 40.25
Southwest Towing, Inc. is required to conduct pre-employment investigations and record keeping.

Current or Most Recent Employer Information:

Employer Name: *

Work Location: *

Street Address City State / Province / Region Postal / Zip Code

Supervisor/Company Contact: *

Contacts Phone: *

### - ### - ####

Your Position Title: *

Start Date: *

MM / DD / YYYY

First work day with current or most recent employer

End Date:

MM / DD / YYYY

Last work day if currently unemployed

Reason(s) For Leaving: *

Simple Explanation

Terms and Conditions:

I attest that all the information contained in this application is complete and accurate to the best of my knowledge. I understand that false or misleading information may be grounds for disqualification of employment at any stage in the hiring process.

I am aware that my permanent relocation may be required if current residency is not in proximity to the work location that I am applying for.

Type First and Last Name: *

Applicant Signature *

Clear

By signing this application, I agree with the Terms and Conditions detailed above.

If applicable, I consent to the FMCSA required pre-employment MVR and Federal Clearing House Query investigations (for the preceding three years) that Southwest Towing, Inc. will conduct for Tow Truck Operator (CDL) applicants.

Application Date: *

MM / DD / YYYY