Careers | Haines Wrecker Service

EMPLOYMENT APPLICATION

Step 1 of 7

14%

Education
(Required for all driving positions)
High School:*
High School: City & State
City State
From:
To:
Did you graduate?*
- Yes
- No
College:*
College: City & State
City State
From:
To:
Did you graduate?*
- Yes
- No
Major:
Minor:
Degree:
Towing Certifications (WreckMaster, TRAA, Military, etc.):*
Date:
Level:

References
(Required for all positions)
Please list three professional references.
Reference #1
Full Name:*
Relationship:*
Company:*
Phone:*
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #2
Full Name:*
Relationship:*
Company:*
Phone:*
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #3
Full Name:*
Relationship:*
Company:*
Phone:*
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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.
Name:*
First Last
Date:*
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.
Signature
Date*
Driver License (minimum c-class required)*
Accepted file types: jpg, pdf.
Motor Vehicle Report (MVR)*
Accepted file types: jpg, pdf.
DOT Medical Certificate*
Accepted file types: jpg, pdf.
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