Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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YesNo NoYes
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Which position(s) of employment are you seeking? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Which location(s) would you like to apply for employment? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever been convicted of anything other than a minor traffic violation? Please exclude expunged records. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Explanation

Conviction {binding ItemNumber}
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State Conviction Occurred {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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{{ Cognito.resources['fileupload-dropzone-message'] }}
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Please upload your resume in PDF or Word format.

Employment History

Employer {binding ItemNumber}

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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Acknowledgement

Statement of Certification, Authorization, and Agreement & Background Release

In connection with my application for employment with Commercial Works Inc. (CWI), I understand that consumer reports, which may contain public record information, may be requested by our designated background company.  These reports may include the following types of information:  names and dates of previous employers, reason for termination of employment, work experience, etc.  I further understand that such reports may contain public record information concerning my driving record, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information concerning previous driving record requests made by others from such state agencies, and state provided driving records.

I authorize any party or agency to furnish the above-mentioned information to Commercial Works Inc.

I have the right to make a request with Commercial Works, Inc.’s designated background company upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me that have been furnished within the two year period preceding my request.  I hereby consent to CWI obtaining the above information, and I agree that such information which may be obtained, and my employment history with CWI if I am hired, will be supplied to other companies.

In conformity with section 49 C.F.R. Part 40, I hereby authorize the carriers/employers listed in this application to furnish Commercial Works, Inc., or any background company designated by them, with the following information concerning drug and alcohol tests:  DOT drug and alcohol testing violations including pre-employment tests, the carriers conducted during the past two years: (i) the dates on which I tested positive for drugs, and the drug(s) involved; (ii) the dates on which I tested 0.04 or greater for alcohol and the test result levels; (iii) the dates on which I refused (including a verified adulterated or substituted result)  to be tested for drugs and/or alcohol;  (iv) and other violations of DOT drug and alcohol testing regulations; and (v) any information the carriers have received regarding violations of drug/alcohol testing regulations from my previous employers cover by DOT.

I fully understand that the information I authorize Commercial Works, Inc or their designated background company to receive tests which were required by the Department of Transportation (DOT). If any carrier listed in this application furnished information  concerning items (I) through (v) above, I also authorize that carrier to release and furnish: (iv) the dates of my negative drug and/or alcohol tests with results below 0.04 during the two-year period; and (vii) the name and phone number of any substance abuse professional who evaluated me during the past two years.

I have carefully read and fully understand this authorization and certification.  I certify that all of the information that I have furnished is true and complete and that I have listed all of the companies that I have provided services for as driver or applied for work or qualification as a driver during the past three years.

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Commercial Works Inc. (CWI) is a federal contractor and equal opportunity employer, does not discriminate against sex, disability, veteran status, sexual orientation or gender identity.

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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Driver’s License Number & State of Issue (If Applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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State Identification Number & State of Issue (If Applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Are you legally eligible to work in the U.S.? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Which position(s) of employment are you seeking? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Which location(s) would you like to apply for employment? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you ever been convicted of anything other than a minor traffic violation? Please exclude expunged records. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Explanation

Conviction {binding ItemNumber}
Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Disposition {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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County Conviction Occurred {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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State Conviction Occurred {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Description {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Resume {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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{binding Name, mode=oneTime}
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Employment History

Employer {binding ItemNumber}

Business Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Describe work performed, equipment operated, and special accomplishments. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Employed From {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Employed To {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Reason for Leaving {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Acknowledgement

Statement of Certification, Authorization, and Agreement & Background Release

In connection with my application for employment with Commercial Works Inc. (CWI), I understand that consumer reports, which may contain public record information, may be requested by our designated background company.  These reports may include the following types of information:  names and dates of previous employers, reason for termination of employment, work experience, etc.  I further understand that such reports may contain public record information concerning my driving record, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information concerning previous driving record requests made by others from such state agencies, and state provided driving records.

I authorize any party or agency to furnish the above-mentioned information to Commercial Works Inc.

I have the right to make a request with Commercial Works, Inc.’s designated background company upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me that have been furnished within the two year period preceding my request.  I hereby consent to CWI obtaining the above information, and I agree that such information which may be obtained, and my employment history with CWI if I am hired, will be supplied to other companies.

In conformity with section 49 C.F.R. Part 40, I hereby authorize the carriers/employers listed in this application to furnish Commercial Works, Inc., or any background company designated by them, with the following information concerning drug and alcohol tests:  DOT drug and alcohol testing violations including pre-employment tests, the carriers conducted during the past two years: (i) the dates on which I tested positive for drugs, and the drug(s) involved; (ii) the dates on which I tested 0.04 or greater for alcohol and the test result levels; (iii) the dates on which I refused (including a verified adulterated or substituted result)  to be tested for drugs and/or alcohol;  (iv) and other violations of DOT drug and alcohol testing regulations; and (v) any information the carriers have received regarding violations of drug/alcohol testing regulations from my previous employers cover by DOT.

I fully understand that the information I authorize Commercial Works, Inc or their designated background company to receive tests which were required by the Department of Transportation (DOT). If any carrier listed in this application furnished information  concerning items (I) through (v) above, I also authorize that carrier to release and furnish: (iv) the dates of my negative drug and/or alcohol tests with results below 0.04 during the two-year period; and (vii) the name and phone number of any substance abuse professional who evaluated me during the past two years.

I have carefully read and fully understand this authorization and certification.  I certify that all of the information that I have furnished is true and complete and that I have listed all of the companies that I have provided services for as driver or applied for work or qualification as a driver during the past three years.

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Today's Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Commercial Works Inc. (CWI) is a federal contractor and equal opportunity employer, does not discriminate against sex, disability, veteran status, sexual orientation or gender identity.

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