Yazoo River Towing, INC.

YAZOO RIVER TOWING, INC. P.O. BOX 1043 VICKSBURG, MS. 39181 601-636-2454 Fax # 601-636-6805
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Name

First NameMiddle NameLast Name
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Height
Weight
Please select

MaleFemale
Veteran

YesNo
Previously employed by Yazoo River/Big River

YesNo
If yes, when?
Position Applied For
Are you at least 18 years of age?

YesNo
Type a question
Are you now employed?

YesNo
Any merchant document you now hold?
1. Current/Last Employer
Address
Phone
Employment Date
End Date
Reason for leaving
Job Duties
Wage
Contact?

YesNo
2. Employer
Address
Phone
Employment Date
End Date
Reason for leaving
Job Duties
Wage
Contact?

YesNo
3. Employer
Address
Phone
Employment Date
End Date
Reason for Leaving
Job Duties
Wage
Contact?

YesNo
Education: Last grade completed

123456789101112College or Technical School
Have you ever been convicted/charge of a felony?

YesNo
Note, A conviction does not necessarily eliminate you from consideration. Each conviction will be reviewed with respect to the offense and position for which you apply
References:List below the names, address and phone number of references not related to you.
Download the pre-employment release form: Click Here
I have read, and agree to the pre-employment release form*

I agree
Signature for the pre-employment release form:*

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Can you swim?

YesNo
List any special skill or training you have received
Do you have a driver's license?

YesNo
Do you have a TWIC card?

YesNo
I hereby certify that the information provided in this application is freely given, true andcomplete. I understand that any false, fraudulent, or misleading statements, answers orinformation may be sufficient grounds for immediate rejection of my application ordismissal from service if hired. I authorize the Human Resource Office to verifyinformation given on this application and/or contact my present, and past employers.
Signature

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Date

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Date
After clicking "Submit" you will be redirected to the Pre-Employment Release form. Please fill that out as well.
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YAZOO RIVER TOWING, INC. P.O. BOX 1043 VICKSBURG, MS. 39181 601-636-2454 Fax # 601-636-6805