Fry-Wagner Moving & Storage | Agent for United Van Lines

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Online Application

Can you, if selected for employment, submit verification of your legal right to work in the United States?		Yes No (Required)
Date of Birth		-- (DD-MM-YYYY) (Answer only if applying for Driver, Mover, Packer and Commercial Mover Supervisor Positions)
First Name		(Required)
Middle Initial
Last Name		(Required)
Address		(Required)
City		(Required)
State		(Required)
Zip		(Required)
Phone		Ext. (Required)
Fax
Alternate Phone		Ext.
Pager
E-Mail Address		(Required)
Previous Cities and States Lived in the Past 7 Years

Employment History		Please provide employment history within the last 10 years listing the most recent first.

Present Employer
Dates of Employment		From To
Employer Name
Address
City
State
Zip
Phone		Ext.
Position
Supervisor's Name
May we contact this employer?		Yes No

Name of Previous Employer #1
Dates of Employment		From To
Employer Name
Address
City
State
Zip
Phone		Ext.
Position
Supervisor's Name
May we contact this employer?		Yes No

Name of Previous Employer #2
Dates of Employment		From To
Employer Name
Address
City
State
Zip
Phone		Ext.
Position
Supervisor's Name
May we contact this employer?		Yes No

Driver's License Information
NOTE: This section only needs to be completed by applicants who are applying for a Commercial Driver position.
State of Issue
Drivers License Number
Type of License
Expiration Date

Number of Tickets/Citations, if any, received in the last five years
		If applicable, please describe the nature of the ticket(s)

Number of accidents, if any, in the last five years
		If applicable, please describe the amount of damage

Have you ever received a DUI/DWI?		Yes No
Has your license ever been suspended?		Yes No
Have you ever been convicted of a crime		Yes No If yes, give approximate date

Dock, driving, yard and shop jobs may require physical agility and heavy exertion and lifting. Can you perform the required functions of this job with or without reasonable accomodations?		Yes No

In connection with my application for employment (including contract for services) I voluntarily consent to and authorize ABC/Fry-Wagner, Inc., Fry-Wagner Moving & Storage Co., or Fry-Wagner Mid-Missouri, Inc., herein referred to as the Company, and or their assigned agents, associates, or consumer reporting agencies to request and receive any Consumer Reports, Investigative Records, Criminal Records, Civil Records, Motor Vehicle/Driving Records, Credential Verification, Employment Verifications, Past Employment Verifications, Education Verifications, Reference Checks, Military Service Verifications, and Consumer Credit Reports. I authorize any persons, organizations, companies, corporations, consumer reporting agencies, courts of law, licensing agencies, schools, and any current or past employer to furnish Company and or their assigned agents, associates or consumer reporting agencies with any and all information concerning me. I further agree to release Company and or their assigned agents, associates, or consumer reporting agencies and all persons and organizations providing information from any and all claims, liability and responsibility arising out of the release of such information in connection with this research. I understand that I have specific prescribed rights as a consumer under The Federal Fair Credit Reporting Act (FCRA) and may have additional rights under relevant specific state laws. This authorization does not include a release of my medical information. I have read the above release and I give permission to obtain consumer reports about me. I have read the above release and I DO NOT give permission to obtain consumer reports about me.

Celebrating 100 Years

Copyright 2007 Fry-Wagner Moving & Storage
Missouri FMCSA #MC-169343 | Illinois C.C. 1083 MC
Fry Wagner is an authorized agent of United Van Lines
US DOT # 77949