APPLICATION FOR EMPLOYMENT Step 1 of 4 25% Non-Discrimination Policy: J&M Towing is committed to the principle of equal opportunity in education and employment. J&M Towing does not discriminate on the basis of sex, race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability in admission to, access to, treatment in, or employment in its programs and activities.GENERAL INFORMATIONReferral Source(Required) Craigslist Friend Relative Google Facebook Walk-in Current Employee. If yes, answer below Other. Answer below Current Employer?OtherName(Required) First Middle Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home PhoneCell Phone(Required)Email(Required) Have you ever filed an application here before?(Required) Yes No If yes, give approx. date(Required)Have you ever been employed here before?(Required) Yes No If yes, give date(Required)Are you currently employed?(Required) Yes No If yes, may we contact your employer?(Required) Yes No Employment desired:(Required) Full-Time Part-Time Shift Work Temporary Overtime When are you available for work?(Required)Are you on a lay-off and subject to recall?(Required) Yes No VEHICLESWhat type of vehicles have you used before? Check all that apply.(Required) Flatbed Heavy Rotator Lowboy Trailer Wheel Lift Medium Landoll Trailer Rolloff Trailer DRIVERS LICENSEDo you have a driver’s license?(Required) Yes No Driver’s license number(Required)State of issue(Required)Untitled(Required) Operator Commercial (CDL) Expiration date(Required)Social Security Number:(Required)Have you had any accidents during the past ten years?(Required) Yes No If yes, how many?(Required)Have you had any moving violations during the past ten years(Required) Yes No If yes, how many?(Required)MEDICAL CARDDo you have a valid medical card?(Required) Yes No Upload a copy here(Required)Max. file size: 256 MB. OTHER SPECIAL SKILLSPlease list other special skills you may have, e.g., fluency in other languages, licenses, special training required for the position for which you are applying, etc.(Required) Add Remove WORK EXPERIENCE Please list your work experience beginning with your most recent job. If you were self-employed, give firm name. Attach additional sheets if necessary. Exclude organization names which indicate race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability.Most Recent EmployerDates EmployedFrom(Required) MM slash DD slash YYYY To(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Supervisor(Required)Job Title(Required)Reason For Leaving(Required)Work Performed(Required)EmployerDates EmployedFrom(Required) MM slash DD slash YYYY To(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Supervisor(Required)Job Title(Required)Reason For Leaving(Required)Work Performed(Required) WAIVERS AND DISCLOSURES Please read each section carefully and sign where indicated. AT-WILL EMPLOYMENT It is my understanding that this employment application, or the granting of an oral interview, does not represent a contract of employment or a promise of future benefits by this organization. I understand and agree that, if hired; my employment will be at-will in nature and may be terminated, with or without cause, at any time, by either myself or my employer. Personal calls/texts and any non-work related cellphone use while working are grounds for dismissal. I also understand that this written statement supersedes any and all oral representations made by agents or representatives of this organization. CERTIFICATION OF TRUTH AND ACCURACY I certify that the information in this application is true, complete and correct. I understand that false answers, statements, or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge. NOTIFICATION AND AUTHORIZATION TO REQUIRE A MEDICAL EXAMINATION I hereby certify that, if hired, I will disclose any limitations I have that may impact my ability to do the job. I understand that I may also be required to undergo a pre-employment or post-employment medical exam by J&M Towing designated health practitioner. NOTIFICATION AND AUTHORIZATION TO CONDUCT BACKGROUND INVESTIGATION I understand that I may be subject to a background check, and hereby authorize J&M Towing, to investigate my background to determine any and all information of concern as to my record, whether same is of record or not, and I release employers and persons named in my application from all liability for any damages on account of his/her furnishing said information. Additionally, you are hereby authorized to make any investigation of my personal history, educational background, military record, motor vehicle records, criminal records and credit history through an investigative or credit agency or bureau of your choice. I authorize the release of this information by the appropriate agencies to the investigating service. This authorization, in original or copy form, shall be valid for this and for any future reports and updates that may be required. I understand that passing the background check is a condition of employment. A negative background check can be grounds for dismissal, even if an offer has been made to me and I have been hired. Print Name Here(Required) First Last Please Sign Here(Required)Date(Required) MM slash DD slash YYYY J & M Address Location: 116 Dorsa Avenue Wayne, NJ 07470 Phone: 973-696-9390 Fax: 973-709-0749 J & M Services
