application

Employment/Driver Application

It is our policy to comply with all applicable state and federal laws prohibiting discrimination based on race, age, color, sex, religion, national origin, disability or other protected classifications. Please carefully read and answer all questions. You will not be considered for a position if you fail to completely answer all the questions on this application. You may attach a resume, but all questions on the application must be answered. Failure to answer required questions will result in the incomplete application being discarded/unable to be reviewed. We do participate in the TN Drug Free Workforce Program. If hired, you will be required to fill out a more extensive application packet, as well as complete a pre-hire drug screen & an MVR check to ensure insurance qualifications to work for our Company are met.

Date

Month

Day

Year

Position

First name

Last name

Phone

Address

Birthday

Month

Day

Year

Date You Can Start Work

Salary Desired

Are you authorized to work in the U.S. on an unrestricted basis?

Have you ever been convicted of a felony?

Have you been told the essential job functions or have you viewed a copy of the job description listing the essential functions of the job?

Are you able to perform the essential functions of the job with or without reasonable accommodations?

Special Skills: Please list any special skills or experience that you feel would help you in the position you're applying for.

Qualifications: Please list any education or training you feel relates to the position applied for that would help you perform the work, such as but not limited to: schools/colleges, degrees/certificates; military training.

References: Required Please list three professional references, not related to you with the full name, address, phone number, and relationship. If you do not have professional references please list unrelated personal references.

Work History: Start with your present or most recent employer and work back.

May we contact your present or previous employers to verify your employment?

Company Name & Address-City/State/Zip

Start Date (MONTH/DAY/YEAR) & End Date (MONTH/DAY/YEAR)

Job Title

Job Description/Responsible Duties

Supervisor's Name and Phone Number

Reason for leaving

Company Name & Address-City/State/Zip

Start Date (MONTH/DAY/YEAR) & End Date (MONTH/DAY/YEAR)

Job Title

Job Description/Responsible Duties

Reason for leaving

Company Name & Address-City/State/Zip

Start Date (MONTH/DAY/YEAR) & End Date (MONTH/DAY/YEAR)

Job Title

Job Description/Responsible Duties

Supervisor's Name and Phone Number

Reason for leaving

Upload Resume or relevant certificate of training

I certify that the facts set forth in this Application for an employment position are true and complete to the best of my knowledge. I understand that if I am contracted: false statements, omissions or misrepresentations may result in a termination of my contract. I authorize REACT Recovery, LLC to make an investigation of any of the facts set forth in this application and release REACT Recovery, LLC from any liability. REACT Recovery, LLC may contact any listed references on this application.

Signature

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MVR Request Form

For the sole purpose of the determination and evaluation of my motor vehicle operating record and pursuant to the Federal and State regulations of compliance, I authorize React Recovery LLC and their insurance company to obtain my Motor Vehicle Record for insurance eligibility and underwriting purposes. I understand that this record may contain personal identification** as well as any/all driver violations and/or accidents which may be on record through the Deptartment(s) of Motor Vehicles.

Printed Name

First name

Last name

Phone

Driver's License Number

State

Date of Birth

Address

Country/Region

Address

City

Zip / Postal code

Signature

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**Personal Information is included but not limited to: information that identifies an individual including the applicant's photograph, driver identification number, name, address and phone number.

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Employment/Driver Application

MVR Request Form

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