Non- Driver Application

Non-Driver Application Form

"*" indicates required fields

Step 1 of 4

Today's Date*

Your Name*

First Middle Initial Last

Current Address*

Street Address Address Line 2 City State ZIP Code

Past 3 Years of Residency

Address*

Street Address Address Line 2 City State ZIP Code

Address*

Street Address Address Line 2 City State ZIP Code

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone:*

Social Security Number*

Date of Birth*

Email*

Hours / Shifts you are seeking:*

Select all that apply

Desired Position*

Terminal Location*

Lenexa, KS

Blue Springs, MO

Joplin, MO

Dallas, TX

Date You Can Start*

Days Available*

Salary Desired*

Please indicate per year or per hour

How did you hear about Santa Fe Tow Service or this position you are applying for?*

Have you ever been convicted of any crime or are you a convicted felon?*

Yes

Education

High School*

High School Location*

Years Completed*

College

College Location

Years Completed

Vocational/Tech School

Vocational/Tech School Location

Years Completed

Military Service

Branch

Years Served

Skills / Qualifications

List Special Skills, Proficiencies, or Talents that you can bring to Santa Fe Tow service:*

List Certifications, Licenses, or Qualifications you have:*

List Special Training or Awards you have received:*

Current or Last Employer*

Current or Last Employer Address

Street Address Address Line 2 City State ZIP Code

Position Held*

Dates Employed*

From To

Reason for Leaving*

Second Last Employer*

Second Last Employer Address

Street Address Address Line 2 City State ZIP Code

Second Last Employer Position Held*

Second Last Employer Dates Employed*

From To

Second Last Employer Reason for Leaving*

Third Last Employer*

Third Last Employer Address

Street Address Address Line 2 City State ZIP Code

Third Last Employer Position Held*

Third Last Employer Dates Employed*

From To

Third Last Employer Reason for Leaving*

Authorization

Affidavit, Consent, and Release

Please read each statement carefully before signing

I have read and understood the pre-employment policies of Santa Fe Tow service.

I certify that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge.

I authorize Santa Fe Tow Service to make such investigations and inquiries of my personal, employment, financial, or medical history, and other related matters as may be necessary for 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 employer, school, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interviews may result in discharge. I understand, also, that I am required to abide by all the rules and regulations of Santa Fe Tow Service.

I understand that information I provide regarding current and/or previous employers may be used, and those employers will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(b) and (e). I understand that I have the right to:

• Review information provided by current/previous employers;
• Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to Santa Fe Tow service; and
• Have a rebuttal statement attached to the alleged erroneous information if the previous employer and I cannot agree n the accuracy of the information.

E-Signature*

First Last

Date*

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