MIDWAY WRECKER SERVICE
Employment Application
    APPLICANT INFORMATION
Last Name:
First Name:
M.I.:
Street Address:
Apt/Unit #:
City:
State:
ZIP:
Date of Birth:
Home Phone:
Cell Phone:
Date Available to Work:
E-mail:
Position Applied For:
Are you a citizen of the United States?
YES
NO
If no, are you authorized to work in the U.S.?
YES
NO
Have you ever worked for Midway Wrecker Service before?
YES
NO
If yes, please give dates and positions
Have you ever pleaded "guilty" or "no contest" to, or been convicted of a crime?
YES
NO
If yes, please provide date(s) and details
    PREVIOUS EMPLOYMENT
Company:
Phone:
1
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Resposibilities:
From:
To:
Reason for leaving:
May we contact your previous supervisor for reference?
YES
NO
Company:
Phone:
2
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Resposibilities:
From:
To:
Reason for leaving:
May we contact your previous supervisor for reference?
YES
NO
Company:
Phone:
3
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Resposibilities:
From:
To:
Reason for leaving:
May we contact your previous supervisor for reference?
YES
NO
Company:
Phone:
4
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Resposibilities:
From:
To:
Reason for leaving:
May we contact your previous supervisor for reference?
YES
NO
    EDUCATION
High School:
Address:
From:
To:
Did you graduate?
YES
NO
Degree:
College:
Address:
From:
To:
Did you graduate?
YES
NO
Degree:
Other:
Address:
From:
To:
Did you graduate?
YES
NO
Degree:
    REFERENCES
Full Name:
Relationship:
Company:
Phone:
Full Name:
Relationship:
Company:
Phone:
Full Name:
Relationship:
Company:
Phone:
    MILITARY SERVICE
Branch:
From:
To:
Rank at discharge:
Type of discharge:
If other than honorable, explain:
    AMBITIONS
What is your greatest strength?
Weakness?
Where do you see yourself in 10
years?
Do you have a passion, interest,
or hobby you pursue in your free
time?  If so, please briefly tell us
about it!
    DISCLAIMERS
I am aware of the pre-employment drug screening policy, as required by T.D.L.R.
(The policy may be reviewed at http://www.license.state.tx.us/towing/drugtesting.pdf)
I AGREE
I certify that my answers are true and complete to the best of my knowledge. If this
application leads to employment, I understand that false or misleading information

in my application or interview may result in my release.
I AGREE