• Date Of Application
     - -
    2 digit month, 2 digit day, 4 digit year
  • DOB*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Select Type of License*
  • State Issued*
  •  -

  • GENERAL INFORMATION

  • Are you able to perform the essential job function of the position for which you are applying with or without reasonable accommodation?*
  • Have you ever been convicted of a Felony or Misdemeanor other than minor traffic violations during the past seven years? (A criminal record or a conviction will not automatically bar employment, but will be considered only as reasonably relates to your fitness to perform the position for which you are applying)*

  • EDUCATION & TRAINING

  • If Required, will you work Rotating Shifts?*
  • If Required, will you work Overtime?*
  • If Required, will you work Saturdays*
  • If Required, will you work Sundays*

  • Employment History

    Start with your PRESENT or MOST RECENT EMPLOYER list on consecutive order ALL EMPLOYMENT for at least past FOUR employers.
  • If currently employed, may we contact*
  •  -
  • Start Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Previous Employment

  •  -
  • Start Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Previous Employment

  •  -
  • Start Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Previous Employment

  •  -
  • Start Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • READ CAREFULLY

  • Official Disclosure Statement:

    I certify that I personally completed this application and that all of the information is true and correct to the best of my knowledge and understand that my any misstatement or omission of information may result in denial of employment or discharge. I authorize the references listed above to give you any and all information concerning my previous employment and any parliament information they have, personal or otherwise, and release all parties from liability for any damage that may result from furnishing same to you.

    Authorization to Release Records

    I authorize the carrier subscribers indicated on this application to do a complete background investigation in accordance with state and federal laws. I authorize my previous employers to release any information requested by these carrier subscribers and hold them harmless of all liability from the release of said information.

    In conjunction with my potential employment at Texas Fueling Services, Inc.(“the company”), I consent to the release of my Motor Vehicle Records (MVR) to the company. I understand the company will use these records to evaluate my suitability to fulfill driving duties that may be related to the position for which I am applying. I also consent to the review, evaluation, and other use of any MVR I may have provided to the company.

    This consent is given in satisfaction of Public Law 18 USC 2721 et. Seq., “Federal Drivers Privacy Protection Act”, and is intended to constitute “written consent” as required by this Act..

    I hereby request and authorize to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold harmless of all liability all companies, agents and associated parties for the use of this application.

  • Choose ONE:*
  • Signature
  • Should be Empty: