Driver Application Form

Name First Middle Last

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E Mail

Address

0/200

Please provide your full address

Cell Phone

Married

Yes No

Driver's License Number

Driver's License EXP Data

Driver's License CLASS

HAS YOUR LICENSE EVER BEEN REVOKED OR SUSPENDED?

Yes No

IF YES, EXPLAIN:

0/1

HAVE YOU EVER BEEN CITED FOR A DUI/DWI?

Yes No

IF YES, EXPLAIN:

HAVE YOU EVER BEEN BONDED?

Yes No

HAVE YOU EVER BEEN REFUSED A BOND?

Yes No

IF YES, EXPLAIN:

HAVE YOU EVER FILED BANKRUPTCY OR HAD YOUR WAGES GARNISHED?

Yes No

IF YES, EXPLAIN:

HAVE YOU EVER BEEN TERMINATED FROM A JOB?

Yes No

DATE OF LAST DOT PHYSICAL:

LIST ANY DRIVING SCHOOLS, RECOVERY COURSES, SAFETY/DRIVING AWARDS:

HAVE YOU EVER FILED FOR LOST TIME OR INJURY THROUGH WORKER’S COMPENSATION INSURANCE?

Yes No

IF YES, EXPLAIN:

ARE YOU CURRENTLY UNDER A DOCTOR’S CARE?

Yes No

IF YES, EXPLAIN:

DO YOU HAVE ANY PHYSICAL LIMITATIONS THAT WOULD AFFECT YOU SO THAT IT WOULD HINDER YOU FROM MEETING THE REQUIREMENTS OF THIS JOB?

Yes No

IF YES, EXPLAIN:

HAVE YOU EVER BEEN CONVICTED OF A CRIME?

Yes No

IF YES, EXPLAIN:

HAVE YOU EVER BEEN TERMINATED FROM A JOB?

Yes No

IF YES, EXPLAIN:

DO YOU HAVE ANY JOB LIMITATIONS?

Yes No

IF YES, EXPLAIN:

LIST THREE CHARACTER REFERENCES (DO NOT LIST PREVIOUS EMPLOYERS) NAME ADDRESS - PHONE - YEARS KNOWN

Attach Driver's License

legal

IT IS AGREED AND UNDERSTOOD THAT PHILIP A WEBB DBA WEBB’S TOWING &
RECOVERY OR IT’S AGENTS MAY INVESTIGATE MY BACKGROUND TO ASCERTAIN ANY AND
ALL INFORMATION OF CONCERN TO MY RECORD, WHETHER SAME IS OF RECORD OR NOT,
AND I RELEASE PHILIP A WEBB DBA WEBB’S TOWING & RECOVERY AND PERSONS NAMED
HEREIN FROM ALL LIABILITY FOR ANY DAMAGES ON ACCOUNT OF THEIR FURNISHING SUCH
INFORMATION.
IT IS ALSO AGREED AND UNDERSTOOD THAT UNDER THE FAIR CREDIT REPORTING
ACT, PUBLIC LAW 91-508, I UNDERSTAND THIS INVESTIGATION MAY INCLUDE A CONSUMER
REPORT, INFORMATION ABOUT MY CHARACTER, GENERAL REPUTATION, PERSONAL
CHARACTERISTICS, AND MODE OF LIVING.
IT IS AGREED AND UNDERSTOOD BY MY SIGNATURE BELOW THAT I ASSUME FULL
RESPONSIBILITY FOR ANY DAMAGES TO VEHICLES, RADIOS, AND EQUIPMENT UNDER MY
CARE AND I AGREE TO PAY FOR DAMAGES THAT I CAUSE TO ANY VEHICLES, EQUIPMENT, OR
RADIOS WHILE UNDER MY CARE.

THIS COVERS THE INVENTORY LIST FOR MY TRUCK. PLEASE UNDERSTAND THAT ANY
DAMAGED OR LOST EQUIPMENT WILL BE REPLACED BY MANAGEMENT AND WILL BE
DEDUCTED FROM YOUR PAYCHECK.
I CERTIFY THAT THE ANSWERS GIVEN HEREIN ARE TRUE TO THE BEST OF MY
KNOWLEDGE. ANY MISREPRESENTATIONS OF INFORMATION SHALL BE CONSIDERED AN ACT
OF DISHONESTY AND COULD/WILL RESULT IN IMMEDIATE TERMINATION. IT IS AGREED AND
UNDERSTOOD THAT THIS APPLICATION FOR EMPLOYMENT UNDER THE DOT REGULATIONS IN
NO WAY OBLIGATES PHILIP A WEBB DBA WEBB’S TOWING & RECOVERY TO QUALIFY OR HIRE
ME. IT IS ALSO UNDERSTOOD THAT IF I AM HIRED, I WILL BE PLACED ON A PROBATIONARY
PERIOD DURING WHICH TIME I MAY BE TERMINATED WITHOUT RECOURSE.

Fields with (*) are compulsory.

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