E-Mail Address Send a Carbon Copy of this Application to Your E-Mail Address Entered Above? No Yes First Name Middle Last Name Address City State Zip Phone Position applying for: Please choose one Customer Service Mechanic Dispatch Clerk   Education Completed High School Some College College Degree Tech College Advanced Degree   Employment History   Dates of Employment: From To Employer's Name Address City State Phone Position Salary Reason for leaving   Dates of Employment: From To Employer's Name Address City State Phone Position Salary Reason for leaving   Dates of Employment: From To Employer's Name Address City State Phone Position Salary Reason for leaving I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize ACT 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 ACT harmless of all liability for providing this application for my use.