YAZOO RIVER TOWING, INC. P.O. BOX 1043 VICKSBURG, MS. 39181 601-636-2454 Fax # 601-636-6805
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Name
First Name
Middle Name
Last Name
Street Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
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Area Code
Phone Number
Height
Weight
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Male
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Veteran
Yes
No
Previously employed by Yazoo River/Big River
Yes
No
If yes, when?
Position Applied For
Are you at least 18 years of age?
Yes
No
Type a question
Are you now employed?
Yes
No
Any merchant document you now hold?
1. Current/Last Employer
Address
Phone
Employment Date
End Date
Reason for leaving
Job Duties
Wage
Contact?
Yes
No
2. Employer
Address
Phone
Employment Date
End Date
Reason for leaving
Job Duties
Wage
Contact?
Yes
No
3. Employer
Address
Phone
Employment Date
End Date
Reason for Leaving
Job Duties
Wage
Contact?
Yes
No
Education: Last grade completed
1
2
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12
College or Technical School
Have you ever been convicted/charge of a felony?
Yes
No
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.
Can you swim?
Yes
No
List any special skill or training you have received
Do you have a driver's license?
Yes
No
Do you have a TWIC card?
Yes
No
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.
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