Application for Employment Uso para el empleo FORM # P001b Page 1 2447 E. Hwy 356 Irving, Texas 75060 Personal Information \ Información Personal Date \ Fecha: Drivers License Number: Name \ Nombre Social Security Number: Seguro Social: Address \ Dirección Home Phone: Teléfono de Casa # City, State, Zip Code Ciudad, Estado, Código postal Other Number: Teléfono Cellular # EMAIL ADDRESS: Have you ever applied for employment with us? [ ] yes [ ] no If Yes: Month: Year: Have you ever been employed with us? ¿Has trabajado con Dallas Trailer Repair Co. anteriormente? [ ] yes [ ] no If Yes: Month: Year: Do you have relatives employed with us? ¿Es usted relacionado con cualquier persona empleada aquí? [ ] yes [ ] no Name \ Nombre: ¿Usted ha solicitado trabajo con Dallas Trailer Repair Co. anteriormente? Relation \relacionado cómo: Are you legally eligible for employment in the United States? [ ] yes [ ] no ¿Es usted legalmente elegible para el empleo en los Estados Unidos? Apart for religious observance, are you available for full time work? Are you over the age of 18? [ ] yes [ ] no ¿Es usted mayor de 18 años? [ ] sí [ ] no [ ] yes [ ] no [ ] yes [ ] no ¿Aparte de observancia religiosa, está usted disponible para el trabajo a tiempo completo? Have you ever been convicted of a felony? ¿Has estado condenado por un crimen? * Conviction will not necessarily disqualify an applicant for employment * * Trabajado horas extra si se te pide * Will you work overtime if asked? ¿Trabajará horas extras si en necesario? [ ] yes Position Desired? ¿qué posición está usted solicitando? [ ] no Pay Expected ¿La Paga Esperó? $ Other Special Training or Skills (languages, machine operation, etc.) ¿Hay habilidades o entrenamiento especiales que usted tenga? (idiomas, operación de máquina, etc.) How did you learn about us? ¿Cómo supo de nosotros? [ ] FRIEND [ ] RELATIVE [ ] WALK-IN [ ] EMPLOYMENT AGENCY [ ] ADVERTISEMENT AMIGO PARIENTE CAMINÓ ADENTRO AGENCIA DE COLOCACIÓN ANUNCIO [ ] OTHER OTRO Military Did you serve or are you serving in the United States armed forces? [ ] yes [ ] no What Branch? [ ] yes [ ] no How? Describe any relevant training? Are you still in Reserve for service which could effect your attendance? Application for Employment Uso para el empleo FORM # P001b Page 2 Employment Experience / Experiencia del Empleo 1 Employer Patron Address direccion Telephone # telefono Supervisor Starting Comienzo Employer Patron Address direccion Telephone # telefono Dates Employed Fechas Empleadas From To Hourly Rate / Salary Salarios Cada hora / Sueldo Supervisor Starting Comienzo Employment Experience / Experiencia del Empleo Employer Patron Address direccion Telephone # telefono Dates Employed Fechas Empleadas From To Hourly Rate / Salary Salarios Cada hora / Sueldo Supervisor Starting Comienzo Employment Experience / Experiencia del Empleo Employer Patron Address direccion Telephone # telefono Work Performed Trabajas Realizado Final Extremo Dates Employed Fechas Empleadas From To Job Title Titulo del trabajo Hourly Rate / Salary Salarios Cada hora / Sueldo Supervisor Starting Comienzo Reason For Leaving? Razon de irse? Work Performed Trabajas Realizado Final Extremo Job Title Titulo del trabajo Reason For Leaving? Razon de irse? Work Performed Trabajas Realizado Final Extremo Job Title Titulo del trabajo Reason For Leaving? Razon de irse? 4 Dates Employed Fechas Empleadas From To Hourly Rate / Salary Salarios Cada hora / Sueldo Employment Experience / Experiencia del Empleo 3 No entre en contacto con por favor a patrones siguientes (indique porqué) circundan por favor número correspondiente: 1 2 3 4 Job Title Titulo del trabajo Reason For Leaving? Razon de irse? 2 Please do not contact the following employers (Indicate why) Please circle corresponding number: 1 2 3 4 Work Performed Trabajas Realizado Final Extremo Waiver Box: By Signing, you give us permission to contact the above noted Previous employers; you give these previous employers permission to disclose information about you; you waive your right to legally pursue any person who discloses such information as a result of our background examination. SIGNATURE DATE Application for Employment Uso para el empleo FORM # P001b Education Page 3 2447 E. Hwy 356 Irving, Texas 75060 Name & Address of School Completed Elementary [ ] Yes / Si [ ] No High School [ ] Yes / Si [ ] No College [ ] Yes / Si [ ] No Graduate Professional [ ] Yes / Si [ ] No Technical [ ] Yes / Si [ ] No Other [ ] Yes / Si [ ] No Languages Fluent Good Diploma or Degree Fair Speak Write Read Please Indicate any foreign languages which you can speak, write or read. Personal References / 1. Reference Address Telephone 2. Reference Address Telephone 3. Reference Address Telephone 4. Reference Address Telephone I attest that I have answered these questions contained herein truthfully. ~ Atestiguo que he contestado a estas preguntas contenidas adjunto verazmente. Signature: Date: APPLICATION FOR EMPLOYMENT PERSONAL INFORMATION Name Social Security Number FIRST MIDDLE LAST Present Address STREET CITY STATE ZIP Permanent Address Email Address Phone Number(s) ( ) - / ( ) - DAYTIME If you are under 18, can you furnish a work permit? Yes No EVENING Driver’s License Number State Issued Class (IF REQUIRED BY YOUR POSITION) EMPLOYMENT DESIRED Position Applied For: Type: Full Time Part Time Are you employed now? Yes Temporary Salary Desired: Date you can start: Seasonal No / / If so, may we contact your current employer? Have you ever applied for a position or worked at eEmployers Solutions, Inc. before? Yes No If yes, When? Where? Are you on lay-off and subject to recall? Yes No Will you travel if job requires it? Will you relocate if the position requires it? Yes No Are you able to meet the attendance requirements of the position? Will you work overtime if required? Yes Yes Yes Yes No No No No Have you ever been denied a bond required for employment or denied a security clearance? Yes No Have you been convicted of a felony in the past seven (7) years? Yes No (A conviction does not constitute an automatic bar to employment unless relevant to the type of employment.) If yes, please explain: EDUCATION Trade, Business Or Other Academic Type of Education Status Name & Location of School # of years Completed Did you graduate? Subjects Studied Currently Attending Last Completed Currently Attending Last Completed VOLUNTARY AFFIRMATIVE ACTION INFORMATION We comply with government regulations including Affirmative Action. In an effort to comply with requirements regarding government record keeping and other legal obligations, we ask that you complete this data survey. Your cooperation is appreciated. Please be advised that your survey is considered confidential information that will not be used in any employment matters. Sex: r Male r Female Race/Ethnic Group: r Hispanic or Latino r Black or African American r White r American Indian/Alaskan Native rAsian r Pacific Islander/Native Hawaiian r Two or more races SPECIAL NOTICE TO VIETNAM VETERANS, DISABLED VETERANS AND INDIVIDUALS WITH PHYSICAL OR MENTAL HANDICAPS OR DISABILITIES: Government contractors subject to the Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and qualified handicapped individuals. PLEASE CHECK IF ANY OF THE FOLLOWING ARE APPLICABLE: r VIETNAM ERA VETERAN r DISABLED VETERAN r HANDICAPPED INDIVIDUAL This information is used to satisfy the Affirmative Action requirements of Section 503 of the Rehabilitation Act or necessitated by another federal law or regulation. SKILLS AND QUALIFICATIONS: Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work with our Company FORMER EMPLOYERS: List below, your last two employers, starting with the most recent one first. Dates Worked Name & Address of Previous Employer Salary Job Title Reason for Leaving From To From To FORMER SUPERVISORS: List below, three supervisors for whom you have worked at some point during the last five years. Name Address Phone Number Years Acquainted ( ) ( ) ( ) FOREIGN LANGUAGE : List any foreign language skills that you have and check the box(s) that best describes your capabilities. Language Speak Read Write Fluent Good Fair Fluent Good Fair Fluent Good Fair CONDITIONS OF EMPLOYMENT Ø I give the Company the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Company and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. Ø It is understood and agreed upon that any mis representation or omission by me in this application will be sufficient cause for cancellation of this application and/or separation from the Company's service if I have been employed. Furthermore, I understand that just as I am free to resign at anytime, the Company reserves the right to terminate my employment at any time, with or without cause and without prior notice. No supervisor or other representative of the company (except the President of eEmployers Solutions, Inc.) has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the above. Ø Reporting to work with impaired abilities; or the possession, consumption or distribution of drugs or alcohol on Company or Client premises and/or worksites, shall be grounds for disciplinary action, including discharge. A condition of employment includes a willingness on the part of the applicant or employee to agree to physical examination, and/or substance testing, if requested by the Company. We are committed to operating a drug free workplace. Violations of our drug and alcohol policy may result in dismissal. Ø The Company is an Equal Opportunity Employer. The Company does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law. Ø Any controversy of any kind arising between the parties under this agreement or otherwise (or any agent, officer, director or affiliate of any party), including but not limited to common law, statutory, tort or contract claims, will be submitted to mediation and, failing settlement in mediation, to binding arbitration, in accordance with the rules of the American Arbitration Association. Arbitration shall be conducted in San Antonio, Texas. Each party will select one person to serves as arbitrator. Those arbitrators will in turn select a single arbitrator to hear the matter. Each party is responsible for its own costs and expenses and will share equally the cost and expenses of the Arbitrator. The arbitration will be subject to and governed by the provisions of the Federal Arbitration Act, 9 U.S.C., Section 1-et seq. The parties hereto stipulate and agree that this agreement involves matters affecting interstate commerce. Ø This application is current for only 60 days. At the conclusion of this time, if I have not heard from the Company and still wish to be considered for employment, it will be necessary to fill out a new application. I have carefully read the above Conditions of Employment and I understand and agree to the terms. _______________________________________ Signature of Applicant ________________________________ Date For DTR Internal use only SERVICES REQUESTED MVR Education Criminal Employment Other Prof. Cred. EMPLOYMENT BACKGROUND CHECK DISCLOSURE AND AUTHORIZATION DISCLOSURE Dallas Trailer Repair Co., Inc. / DTR Transportation Services (“Company”) may obtain information about you from [RED STAR BACKGROUNDS INC. 8000 IH 10 W. STE 600 SAN ANTONIO, TX 78230, 210-524-7707 AND WWW.REDSTARBACKGROUNDS.COM, or another third-party consumer reporting agency, for employment purposes, including without limitation, for the purpose of evaluating you for employment, promotion, reassignment and retention as an employee, at any time prior to or during your employment, if applicable, and without giving you any further notice. Thus, you may be the subject of a background check, also known as a “consumer report” and/or an “investigative consumer report,” which may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may contain, without limitation, all or some of the following types of information about you: credit history, social security number verification, address and alias history, personal references, professional references, employment history, educational history, licenses, certifications, motor vehicle records, driving records, criminal history, and civil court record history. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the applied-for position. You have the right to know whether a consumer report has been obtained about you; and you have the right to request a copy of any report obtained by Company, a copy of “A Summary of Your Rights Under the FCRA,” and a complete and accurate written disclosure of the nature and scope of any investigative consumer report obtained by Company. An investigative consumer report is information on an individual's character, general reputation, personal characteristics, or mode of living is obtained through a personal interview with an information source. The nature and scope of the most common form of investigative consumer report obtained for employment purposes is an interview with a reference, employer, coworker, supervisor, or customer. AUTHORIZATION I acknowledge receipt of the Background Check Disclosure and A Summary of Your Rights Under the FCRA, and certify that I have read and understand both documents. I hereby authorize Company to obtain background check information, including consumer reports and investigative consumer reports, about me from [RED STAR BACKGROUNDS INC.] or another third-party consumer reporting agency, for employment purposes, including without limitation, for the purpose of evaluating you for employment, promotion, reassignment and retention as an employee, at any time prior to or during my employment, if applicable, and without giving me any further notice. To this end, I hereby authorize, without reservation, any credit bureau, creditor, employer, coworker, supervisor, customer, institution, school, college, university, license or certificate granting entity, state department of motor vehicles, state department of revenue, court, governmental agency, law enforcement agency, information service bureau, insurance company, other record-keeping agency, person, administrator, organization, company, corporation, entity, and any other information source, to furnish any and all background information requested by [RED STAR BACKGROUNDS INC., 8000 IH 10 W. STE 600 SAN ANTONIO, TX 78230, 210-524-7797 AND WWW.REDSTARBACKGROUNDS.COM], another third-party acting on behalf of Company, and/or Company itself, and regardless of whether the requested information was received from another source. I agree that a copy of this Authorization shall be as valid as the original. First Name Middle Name Social Security # Driver’s License Number Date of Birth Last Name State Class Authorization Signature Maiden / Other Names County of Residence Date Applicant Screening Form Full Name (First, Middle, Last): Maiden Name/Other Names Used: Maiden Name/Other Names Used: Social Security Number: Drivers License Number: Date last used: Date last used: Date of Birth: State of Issue: Sex: Male Female Have you been convicted of any felonies or misdemeanors since the age of 18 or do you have any action pending with a law enforcement agency? Include courts-martial, military tribunals, probation and deferred adjudication on misdemeanors and felonies. Do not include juvenile convictions or traffic citations. A conviction will not necessarily disqualify an applicant from employment. Yes No If yes, list all violations below, include dates and arresting agency. Attach additional pages if necessary. (A conviction will not necessarily bar an applicant from employment) ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ All addresses for the last SEVEN years: (attach additional pages if necessary) 1. __________________________________________________________________________________________________ Street City County State Zip Years From – To 2. __________________________________________________________________________________________________ Street City County State Zip Years From – To 3. __________________________________________________________________________________________________ Street City County State Zip Years From – To 4. __________________________________________________________________________________________________ Street City County State Zip Years From – To 5. __________________________________________________________________________________________________ Street City County State Zip Years From – To . . Employment History (Show every employment – begin with last or present employer.) Show all employments, beginning with last or present employer. If self-employed, list at least 2 business. Check the appropriate boxes below. May your current employer(s) be interviewed? Yes No Dates (month/year) Check one: Employer self-employed From: ____________ To: ______________ Company Name: ___________________________________Phone:_________________________ Address:__________________________ City:______________ State:____ Zip:_________________ Job Title(s): _______________________________________________________________________ Name of Supervisor or Contact: Dept: ___________________________________________________ Reason for Leaving: ________________________________________________________________ Dates (month/year) From: ____________ To: ______________ Check one: Employer self-employed Company Name:_______________________________________Phone:_____________________ Address:__________________________ City:______________ State:____ Zip:________________ Job Title(s): ______________________________________________________________________ Name of Supervisor or Contact: Dept: __________________________________________________ Reason for Leaving: ________________________________________________________________ Professional Credentials 1. Issuing Authority Phone Issuing State License Type License Number Issue Date/Exp. Date Status Issuing Authority Phone Issuing State License Type License Number Issue Date/Exp. Date Status Issuing Authority Phone Issuing State License Type License Number Issue Date/Exp. Date Status Issuing Authority Phone Issuing State License Type License Number Issue Date/Exp. Date Status 2. 3. 4. Education 1. Institution Name and Address From - To (mo/yr) GPA/Class Standing Major Minor Type of Degree Date Degree Obtained or to be Obtained GPA/Class Standing Major Minor Type of Degree Date Degree Obtained or to be Obtained GPA/Class Standing Major Minor Type of Degree Date Degree Obtained or to be Obtained 2. Institution Name and Address From - To (mo/yr) 3. Institution Name and Address From - To (mo/yr) I hereby certify that all information provided in this authorization is true, correct and complete. Signed this______________ day of_________________________________, 20_____________ . Applicant Signature: ______________________________________________________________ www.redstarbackgrounds.com 8000 IH10 West, Suite 600, San Antonio, TX 78230 References-Etc. Driving Record Authorization Please fax the completed form to : (603) 297-1476 I, ___________________________________________________________________________________ Please print your full name Hereby authorize References-Etc. to obtain and send a copy of my driving record to the address or fax number I have provided. I certify that all information provided by me pursuant to this agreement is true and accurate to the best of my knowledge and I have read, understand and agree to the terms of this agreement. Your Daytime Phone: ___________________________________________________________________ Your Signature: ________________________________________________________________________ Date: ________________________________________________________________________________ Application for Employment Uso para el empleo FORM # P001b Page 4 2447 E. Hwy 356 Irving, Texas 75060 Trailer Mechanic Tool Requirements / Herramenta Necesaria NO or YES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. Tool Box Caja de herramiento Socket Set 1/2” square drive to 1-1/4” Juego de dados Flex Handle 17” Manivela Flexible 17” 6” Extension Extension de 6” Reversible Ratchet Ratchet reversible Set of Open End Wrenches 1/4” - 1-1/4” Llaves abiertas de 1/4” - 1-1/4” Pipe Wrench 10” Llave de pipas 10” Combination Pliers Pinza de combinacion Adjustable Wrench 8” &12” Llaves adjustables 8” & 12” Needle Nose Pliers Piensas de punta larga Diagonal Cutters Cortadoras diagonales Vice Grip Pinzas de presion (3) Screw Drivers—different sizes Desarmadores varios tamanos cinzes (2) Chisels Cinzeles (1) Punch Punzon Set of Standard Hex Head Wrenches Juego de llaves de cabesa hexagonal (2) Ball Peen Hammers 12 oz & 2 lb. Martillos 50’ Drop Light—3 wire plug Luz con extencion de 50 pies 12’ Tape Measure Cintas de medir Cutting Goggles Lentes de corta Center Punch Punzon pora morcar centros Hack Saw Sierra para metales Safety Shoes w/ Steel Toe Botas con punta de seguridad Welder’s Helmet Casco de soldar Chuck Keys—1/4”, 3/8” & 1/2” Llaves de taladro Leather Work Gloves Guantes de trabajo Creeper Camilla de trabajo I understand that I must have all the tools listed above as a condition of my employment. I also understand that any other tools brought onto the premises will be the sole responsibility of myself, the employee. Any tools I bring will be considered brought at my own risk. Dallas Trailer Repair Co. Inc. will not be held responsible for theft or loss of any tools. I also agree to let the company inspect anything going in or out of the premises including tool boxes, lunch boxes, trucks, cars, trailers or any other personal property. Yo entriendo que la lista de herramienta es necesaria para mi condicion de empleo. Tambien entiendo que cualqier otra herramienta que presente al taller, es mi responsibilida como empleado. La compania Dallas Trailer Repair Co. Inc. no sera responsible por perdida de herramienta. Estoy de acuerdo que la compania Dallas Trailer Repair Co. tiene el derecho de inspectionar cualquier caja de herramiento, carros, traques, cualquier propiedad personal. Signature / Firma Date/ Fecha Application for Employment Uso para el empleo FORM # P001b Page 5 2447 E. Hwy 356 Irving, Texas 75060 Excellent Trailer Mechanic Skills Evaluation 1. Brakes, Seals and Cams? Average Below Average Poor Frenos / Retenes / Gavilanes 2. Replace Torque Arms? Remplazo de Brazos de Suspension 3. Tandum Alignment? Alineaciones 4. Electrical Problems? Problemas electricas 5. Repair Wood Floors? 6. Repair Reefer Floor Aluminum? 7. Repair Roll-Up Doors? 8. Repair Swing Doors? Puertas de Libro 9. Repair Reefer Doors? Puertas refrigeradas Reparacion de piso de madera Reparacion de piso de aluminio Puertas de Cortina 10. Replace complete Roof? Remplazo de techo completos 11. Replace Side Panel Dry Box? Paredes de caja seca 12. Replace Side Panel Reefer? Paredes de caja refrigerada 13. Replace Upper and Lower Rails? Remplazo de reil inferior y superior 14. Liftgate Repair? Reparacion de liftgate 15. Welding Steel? Soldar de hierro 16. Welding Aluminum? Soldar aluminio 17. Federal D.O.T. State Inspections? 18. Refrigeration Unit Repair? Certificado de inspecions D.O.T. Reparacion de unidades de refrigeracion (Thermoking) 19. Frame Repair? Reparacion de chasis 20. Pack and Adjust Wheel Bearings? Enpacar y adjustar baleros 21. Paint? Pintar 22. Preparation for Painting Truck / Trailer? Preparacion de carrocerias 23. Assemble Standard Truck Bodies? Ensamblar cajas estandar 24. Build Vent Doors? Installar ventanillas 25. Install Power Take-Offs, Pumps or Wenches? Installar tomas de fuerza o grulas 26. Cut Vents and Install Doors? Cortar ventanas y instaler puertas 27. Decals? Calcamonias 28. Can you drive a Truck and Trailer? Puedes manejar un camion con traila [ ] Yes / Si 29. What is the color coding (wiring color) for lights on the following? [ ] No / No CDL # Licencia commercial # Que color es el codigo para las siguente luces? Brakes Signature Right Turn Left Turn Marker Lights Date Ground Application for Employment Uso para el empleo FORM # P001b 2447 E. Hwy 356 Irving, Texas 75060 Page 6 BACKGROUND INQUIRY AUTHORIZATION In order to be considered for employment with Dallas Trailer Repair Co., Inc. (the company) and it’s affiliated businesses; a personal background inquiry is conducted on all potential applicants. I hereby am informed and understand that this company shall obtain criminal history record information. I understand that I may be disqualified from further employment consideration if I have been convicted of a felony or any offense involving moral turpitude or for not disclosing any conviction. I understand that this criminal history record search may include local, state and nationwide law enforcement agency records and hereby expressly release any law enforcement agency, record holder or individual from any and all liability for releasing any and all information these agencies or individuals may provide. If there is a need for further clarification of my identity, I agree to provide additional information. I confirm that I have been informed that I may review and confirm any negative criminal history data that had been deemed to adversely impact the decision to offer employment. I understand I will be provided with the name of the reporting source, as well as the nature and substance of the criminal record information. The review and confirmation must be obtained from the providing agency. I hereby affirm that all information I have provided in my employment application package is true and accurate to the best of my knowledge and understand that any deliberate falsification, misrepresentation or omission of fact may be grounds for the rejecting me as an employment candidate. By signing this form you are indicating that you understand all of the above statements and that your criminal history record will be checked. The authorization and all attachments to the employment application package become the property of the company. The company reserves the right to accept or reject any applicant. All offers of employment are conditional, upon review of your criminal history by management , and are retractable. All information, which becomes a part of this record, may be revealed to all persons who participate in the selection of employees. I further understand that all information gathered regarding my application will be the property of the company and will not be released to me. The company is an Equal Opportunity Employer and will consider all applications without regard to race, color, national origin, religion, gender, martial status, veteran or military status or disability. DISCLOSURE AND AUTHORIZATION FOR RELEASE OF MVR INFORMATION As part of our driver controls, we may obtain motor vehicle reports (MVR’s) on your driving history. Before we seek such reports, we wish to have your written permission to obtain the information. You have the right, upon written request, to a copy of the MVR. Under the provisions of the Fair Credit Reporting Act, 15 USC, §1681 et.seq., the Americans with Disabilities Act and all applicable federal, state and local laws, I hereby authorize and permit member companies of Dallas Trailer Repair Co., Inc., and all DBA’s of such, my employer and/or my employer’s insurance agent to obtain a MVR. I agree that a copy of this authorization has the same effect as an original. I hereby release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization, from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information. I understand and acknowledge that I may request a copy of my MVR after I have provided proper identification. Member companies of Dallas Trailer Repair Co., Inc., and all DBA’s of such, my employer, and/or my employer’s insurance agent have the continuing right and authority to check and deliver my motor vehicle records on file with the state and other resource, including, without limitation, driving record, financial responsibility information and prior driving information as set forth above and to deliver such records to one another and the company. Period of Active Status This application will be active for one year. After that time, you will need to complete another application to be considered for employment, I attest that I have answered these questions contained herein truthfully. ~ Atestiguo que he contestado a estas preguntas contenidas adjunto verazmente. Signature: Date: Request for Verification of Prior Employment Part 1 of 2 2447 E. Hwy 356 Irving, Texas 75060 Date: Name/Title: Company: Address: RE: Employment Verification for: Dear: __________________________________ has applied for employment with Dallas Trailer Repair Co., Inc. Would you kindly provide us with a statement regarding your experience with this applicant during the applicant’s term of employment with your company? Please complete the information requested below, and fax it back to 972-721-1606 OR email to __________________________________________________ at your earliest convenience. Feel free to call me as well at 972-579-9027. Of course, your reply will be held in the strictest of confidence. Thank you in advance for your assistance. Return Form to: Dallas Trailer Repair Co., Inc. Sincerely, 2447 East Hwy 356 Irving, Texas 75060 ____________________________________________ Name, Title Dallas Trailer Repair Co, Inc. Phone: 972-579-9027 Email:________________________________________ Candidate’s Reference Release I hereby authorize __________________________________________________________ to provide Dallas Trailer Repair Co., Inc. with the information requested in the attached Employment Verification Form. I hereby expressly release __________________________________ from any and all claims which may be related to or arise from the disclosure of the reference information provided by ______________________________________________________ pursuant to this authorization, including, but not limited to, claims for defamation, interference with contract, and negligence. _______________________________________________________ Internal FORM # P001a Page 5
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