JOB APPLICATION

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Personal Information Release Form
This form is my authorization for the City of Grand Prairie, and Dave's Hi-Way Wrecker Service to obtain consumer reports, driving records, and criminal history reports for the purposes of employment with Dave's Hi-Way Wrecker Service. These reports are necessary to evaluate my insurability under Dave's Hi-Way Wrecker Service's insurance coverage and contractual agreement with governmental agencies of which Dave's Hi-Way Wrecker Service conducts business with. By signing this disclosure, I authorize the above mentioned parties to obtain these reports from time to time, as they deem appropriate to evaluate my employment status or other permissible purposes.
Name*
First Last
Driver's License Number*
State*
Date of Birth*
Social Security Number*
Signature*
Type in your name to sign this form.
City*
State*
Zip Code*
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Dave's Hi-Way Wrecker Service, Inc
The company identified above is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religion, marital status, sexual orientation, political belief or disability.
Date*
Personal Data
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Social Security Number*
Daytime phone number at which we may contact you:*
Are you 18 years of age or older?*
- Yes
- No
Have you ever been convicted of a crime?*
- Yes
- No
Please Explain*
Position Preferred*
Pay rate desired*
Specify: hour, week, or year
Schedule Desired*
- Full Time
- Part Time
- Days
- Nights
Could you work overtime?*
- Yes
- No
What date could you start work?*
Date of Birth*
Email address*
Driver's License No.*
State*
Class and Endorsement*
TRAA National Certification No.*
TDLR License No.*
Exp. Date*
Do you have a legal right to work in the U.S.?*
- Yes
- No
Have you ever been convicted of a crime other than moving violations, including DUI?*
- Yes
- No
Please state the offense, location, date and disposition*
Who should we contact in case of emergency?*
Relationship*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Date you will be available to start work:*
Have you ever applied to this company before?*
- Yes
- No
Have you ever worked for this company before?*
- Yes
- No
How did you learn of this company and/or this position?*
Are you now or do you expect to be engaged in any other work?*
Have you ever been denied a driver's license, permit or privilege to drive?*
- Yes
- No
Please explain:*
Has any license, permit or privilege to drive ever been suspended or revoked?*
- Yes
- No
Please explain:*

Employment History
Dates of employment: From:*
To:*
Employer*
City*
State*
Phone*
Supervisor's Name*
Position Title*
Pay Rate*
Indicate whether the pay was salary, hourly, weekly, or monthly.
Reason for Leaving*
Indicate whether the pay was salary, hourly, weekly, or monthly.
May we contact your employer?*
- Yes
- No
Dates of employment: From:
To:
Employer
City
State
Phone
Supervisor's Name
Position Title
Pay Rate
Indicate whether the pay was salary, hourly, weekly, or monthly.
Reason for Leaving
Indicate whether the pay was salary, hourly, weekly, or monthly.
May we contact your employer?
- Yes
- No
Dates of employment: From:
To:
Employer
City
State
Phone
Supervisor's Name
Position Title
Pay Rate
Indicate whether the pay was salary, hourly, weekly, or monthly.
Reason for Leaving
Indicate whether the pay was salary, hourly, weekly, or monthly.
May we contact your employer?
- Yes
- No
Dates of employment: From:
To:
Employer
City
State
Phone
Supervisor's Name
Position Title
Pay Rate
Indicate whether the pay was salary, hourly, weekly, or monthly.
Reason for Leaving
Indicate whether the pay was salary, hourly, weekly, or monthly.
May we contact your employer?
- Yes
- No

Will you abide by the safety rules of Dave's Hi-Way Wrecker Service?*
- Yes
- No
Are you willing to take a physical exam?*
- Yes
- No
Do you take any illegal or non-prescribed drugs?*
- Yes
- No
Are you willing to take random drug and alcohol screenings?*
- Yes
- No
How many days have you missed from work in the past 3 years?*
- Yes
- No
Are you able to stand and walk for long periods of time?*
- Yes
- No
Are you able to perform this job without any special accommodations?*
- Yes
- No

Applicant's Affidavit
I certify that this application was completed by me and that the answers given by me to the foregoing questions and statements are true and correct without any consequential omissions of any kind whatsoever. I understand that my misleading or incorrect statements may render this application void, and, if employed, would be cause for my termination. I further agree that DAVE'S HI-WAY WRECKER SERVICE shall not be liable, in any respect, if my employment is terminated because of false statements, answers or omissions made by me in this application. I certify that all statements and answers to questions about my health are true and were made without reservations, agree to expressly waive all provisions of law prohibiting any physician, person, hospital or other institution from disclosing to DAVE'S HI-WAY WRECKER SERVICE any information regarding treatment rendered now or in the future. I further understand that taking drug and alcohol tests are a condition of my employment with DAVE'S HI-WAY WRECKER SERVICE and refusal to take such tests when asked will subject me to termination. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries made in connection with my application.

I hereby acknowledge and understand that, unless otherwise defined by applicable law, any employment relationship with DAVE'S HI-WAY WRECKER SERVICE is of an "at will" nature, which means that the employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless an authorized representative of DAVE'S HI-WAY WRECKER SERVICE specifically acknowledges such change in writing.

I understand that this application for employment shall be considered active for a period of time not to exceed sixty (60) days. If I wish to be considered for employment beyond this time period, I should inquire as to whether applications are being accepted at this time.
Signature of Applicant*
Please type your name here to sign this application
Date of Application*

	Phone: (972) 262-2000
	Phone: (972) 262-1222
	daveshiway@aol.com
	1509 E Main St Grand Prairie, Texas 75050

JOB APPLICATION

Step 1 of 5

Personal Information Release Form

Dave's Hi-Way Wrecker Service, Inc

Personal Data

Employment History

Applicant's Affidavit