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2416 E St NE Auburn, Washington 98002

Fitz Towing

TOWING & TRANSPORT SERVICES

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Employment Application

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Employment Application

Type of Application *

Today's Date: *

What position are you applying to? *

Where did you hear about this position? *

YOUR INFORMATION

Applicant Name: *

First

Last

Email: *

Email

Confirm Email

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone: *

Cell Phone:

Message Phone:

List your address of residency for the past 3 years:

How Long? *

2nd previous address:

How Long? *

3rd previous address:

How Long?

Are you authorized to work in the United States?

Yes
No

Are you at least 22 years of age?

Yes
No

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

Yes
No

When?

Are you employed now?

Yes
No

How long since leaving your last employer?

Are you able to pass a criminal background check?

Yes
No

Please explain:

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

Yes
No

Please explain:

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
No

When?

Reason:

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

Yes
No

When?

Reason:

DRIVING EXPERIENCE (IF APPLICABLE)

I have no professional driving experience

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:

End date: (Leave blank if current)

Type of Equipment: (Van, tank, flat, etc.)

Approx Number of Miles:

TRACTOR - TWO TRAILERS

Start date:

End date: (Leave blank if current)

Type of Equipment: (Van, tank, flat, etc.)

Approx Number of Miles:

TRACTOR - THREE TRAILERS

Start date:

End date: (Leave blank if current)

Type of Equipment: (Van, tank, flat, etc.)

Approx Number of Miles:

MOTOR COACH - SCHOOL BUS

Start date:

End date: (Leave blank if current)

Type of Equipment: (Van, tank, flat, etc.)

Approx Number of Miles:

STRAIGHT TRUCK

Start date:

End date: (Leave blank if current)

Type of Equipment: (Van, tank, flat, etc.)

Approx Number of Miles:

OTHER

Start date:

End date: (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've had no accidents in the last 3 years

I have had no accidents in the last 3 years

1ST INCIDENT (IF APPLICABLE)

Date of accident:

Nature of accident:

Fatalities or injuries:

Type of citation issued:

2ND INCIDENT (IF APPLICABLE)

Date of accident:

Nature of accident:

Fatalities or injuries:

Type of citation issued:

3RD INCIDENT (IF APPLICABLE)

Date of accident:

Nature of accident:

Fatalities or injuries:

Type of citation issued:

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

I've had no accidents in the last 3 years

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

1ST CONVICTION OR FORFEITURE (IF APPLICABLE)

Date:

Location:

Charge:

Penalty:

2ND CONVICTION OR FORFEITURE (IF APPLICABLE)

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: *

End Date:

LEAVE BLANK IF CURRENT EMPLOYER

Address *

Address Line 1

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
No
N/A

Were you subject to the FMCSRs while employed? *

Yes
No
N/A

2ND MOST RECENT EMPLOYER (IF APPLICABLE)

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

Start Date:

End Date:

Address:

Address Line 1

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
No
N/A

Were you subject to the FMCSRs while employed?

Yes
No
N/A

3RD MOST RECENT EMPLOYER (IF APPLICABLE)

Employer Name:

Start date:

End Date:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Position:

Salary:

Supervisor's name:

Phone:

Reason for leaving:

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

Yes
No

Were you subject to the FMCSRs while employed?

Yes
No

EDUCATION

Will there be a resume with this application?

Yes
No

High School:

Location:

Graduated?

Yes
No

College or Technical School:

Location:

Graduated?

Yes
No

College or technical school:

Location:

Graduated?

Yes
No

Any special certificates or classes:

Any special awards or recognitions:

Languages spoken:

TO BE READ AND DIGITALLY INITIALED BY APPLICANT

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. *

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.
I understand that I am required to abide by all rules, regulations and policies of Fitz Towing.
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)
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
No

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
No

I understand I have the right to: *

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

I acknowledge that me typing my initials is a proxy for my physical signature.

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:

Comment

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