Haines Wrecker Service is an equal opportunity employer and does not discriminate in employment on the basis of race, sex, religion, or age.

This application will be given every consideration, buts its receipt does not imply employment. Any offer of employment with this company is contingent on the applicant proving he or she has the proper driver’s license to drive a light‐duty tow truck (minimum C‐Class) or heavy duty wrecker (Class A CDL with endorsements) in the state of Oklahoma, a clean MVR and safety record, and successfully take and pass a DOT medical examination, a pre‐placement drug test, and any background check that the Oklahoma DPS, OCC, or the police department of any municipality that Haines Wrecker Service serves may require.

Applicant Information
(Required for all positions)

Driving History
(Required for all driving positions)

Section 383.21 FMCSR states “No person who operates a commercial motor vehicle shall at any time have more than one driver’s license.” I certify that I do not have more than one motor vehicle license, the information for which is listed below.

Accident record for past 3 years

1st Accident

2nd Accident

3rd Accident

4th Accident

Traffic convictions and forfeitures for the past year (other than parking violations)

Education
(Required for all driving positions)

Work Experience
(Required for all positions)

Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record).

Employer #1

Employer #2

Employer #3

Employer #4

References
(Required for all positions)

Please list three professional references.

Reference #1

Reference #2

Reference #3

Supplemental Information
(Optional)

The following questions are optional, however, applicants that take the time to answer the below questions will be given first consideration over applicants who do not. All questions will require answers at the time of interview.

TO BE READ AND SIGNED BY APPLICANT:

I authorize Haines Wrecker Service to make investigations and inquiries into my personal, employment, criminal, financial, and medical history and any other matters that 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 application.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand, also, that I am required to abide by all rules and regulations of Haines Wrecker Service and that Oklahoma is an “employment at-will” state, meaning that an employer or employee may terminate the relationship at any time, without any reason or cause. I understand that if hired my employment will be on an on “at-will” basis.

I consent to a pre-employment drug screening and understand that I can be drug tested randomly at any point throughout my employment. 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 investigation into my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

1. Review information provided by current/previous employers;
2. Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
3. 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.

My signature certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge

Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.