Telecommut
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Application Date: *
Space
Position Applying For: * Dispatcher
PERSONAL INFORMATION
PERSONAL INFORMATION
Full Name: *
Cell Phone: *
Home Phone:
Date of Birth: *
Social Security #:
Driver License #:
Driver License State:
Street Address: *
Apt. #:
City: *
State: *
Zip: *
Email: *
Date Available: *
Desired Pay: *
Type of Employment Requested: *
Full Time
Part Time
Temporary
Have you ever worked for Midway Wrecker Service before? *
No
Yes
Education & Skills
If yes, indicate under what name and when:
EDUCATION & SKILLS
Education (Select highest year completed):
Education (Select Highest Year Completed) :
High School: *
1
2
3
4
College: *
0
1
2
3
4
Graduate: *
0
1
2
List and describe any experience directly related to the job applying for.
List types of machinery operated and/or computer skills (programs, applications) which you feel are relevant to the job applying for.
List any Certifications, Licenses or Achievements you feel are pertinent to the job and the date received.
List any other applicable skills/experience/abilities that might benefit the job you desire.
Experience & Employment History
EXPERIENCE & EMPLOYMENT HISTORY
List all jobs
List all jobs, activities, and other significant experience, including volunteer work, part-time employment while in school, U.S. Military Service, and self-employment for the past 7 years. Begin with the most recent.
- Company Name: *
Supervisor: *
Your Job Title: *
Job Duties: *
Date From: *
Date To: *
Pay Rate: *
Pay Frequency: * per Hour per Day per Week per Bi-Week (every other week) per Semi-Month (twice a month) per Month per Quarter per Year
Reason for Leaving: *
May we contact your present employer for references? *
No
Yes
May we contact you at your present place of employment? *
No
Yes
If Yes, Please Provide a Current Telephone Number:
- Company Name: *
Supervisor: *
Your Job Title: *
Job Duties: *
Date From: *
Date To: *
Pay Rate: *
Pay Frequency: * per Hour per Day per Week per Bi-Week (every other week) per Semi-Month (twice a month) per Month per Quarter per Year
Reason for Leaving: *
May we contact your former employer for references? *
No
Yes
If Yes, Please Provide a Current Telephone Number:
EMPLOYMENT REFERENCES
EMPLOYMENT REFERENCES
Employment References List 3
List 3 individuals who are familiar with your on-the-job skills and abilities. These may be immediate supervisors previously noted under the employment section.
- Name: *
Phone Number: *
- Name: *
Phone Number: *
- Name: *
Phone Number: *
PERSONAL REFERENCES
PERSONAL REFERENCES
Personal References List 2
List 2 individuals who are familiar with your skills and abilities. Do not list those previously noted under the employment section.
- Name: *
Phone Number: *
- Name: *
Phone Number: *
CRIMINAL HISTORY
CRIMINAL HISTORY
Have you ever been convicted under your current name or any other name of: (1) a felony, or (2) within the past 5 years of a misdemeanor which resulted in imprisonment? (Note: A conviction is not necessarily a bar to employment.) *
YES
NO
If Yes
If YES, give date, court, nature of offense and disposition below.
Date:
Court:
Disposition:
Nature of Offense:
PLEASE READ THE FOLLOWING
PLEASE READ THE FOLLOWING APPLICANT STATEMENT, CAREFULLY.
REVIEW YOUR APPLICATION BEFORE SUBMITTING.
APPLICANT STATEMENT
NOTE: All job offers are contingent on your furnishing proof of your authorization to work in the U.S. You must also be able to show that you are in one of the following five categories: (1) U.S. citizen or national (2) permanent resident alien (3) temporary resident alien (4) refugee (5) asylee.
- I certify that the answers provided to foregoing questions/statements are true and correct, without mental reservation of any kind. I duly authorize management of Midway Wrecker Service to verify them; and
- I understand that any information provided by me herein found false, incomplete or misrepresented will be sufficient cause to cancel further consideration of this application for employment. And/or if upon investigation, anything in this Application is found to be untrue, I understand that I will be subject to immediate dismissal at any time during the period of employment.; and
- If I obtain employment resulting from this Application, I agree to comply with all orders, rules, regulations, policies, request and procedures of the Midway Wrecker Service; and expect an initial probation period and non-recourse review/s; and
- I acknowledge that this Application does not constitute an agreement or contract for employment for or of an indefinite duration. Employment may be terminated with or without cause and notice at any time, either by Midway Wrecker Service or me; and
- I understand that no member of management, or other official or agent of the Company has authority to make any agreement (oral, written or implied) or other representations contrary to item (2) above. However, the Owner of the Company can do so in written agreement signed by the Owner and me; and
- I understand that any offer of employment by Midway Wrecker Service is conditional upon successfully passing a drug test. Further, I agree to submit to a physical examination which may include a random or appointed test/s for alcohol and/or illegal drugs at the time and the place so requested by employer/s during the course of my employment; and
- I also authorize my former employers and educational institutions to give information they have regarding me. I release them and their organizations from liability for issuing the same; and
- If hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws requires me to complete an I-9 Form in this regard. I also understand and authorize Midway Wrecker Service to verify my right to work status through State and Federal Agencies my I-9 status from such information.
By checking this box, I certify that I fully understand and accept all terms of the foregoing Applicant Statement. *
Thank you for submitting your application.
We will contact you soon.
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