SmallApplication – Blackshirt Oil

Job Application Forms

MVR Disclosure

MVR Disclosure Form

Applicant Information

Name *

First

Last *

Last

Email *

Phone *

Date of Birth

Address *

Address

City

State/Province

Zip/Postal

Driving Experience

Drivers License State

Drivers License Number

Drivers License Type

Expiration Date

Motor Vehicle Reports (MVR's) may be obtained as part of the company's evaluation of my job application or employment. The reports may be procured by Leavitt Group on behalf of the company and will include my driving record and assessment of my insurability under the company's insurance coverages.

By signing this disclosure, I hereby authorize the company to procure such reports, as it deems appropriate to evaluate my insurability.

Signature

Clear

Date

If you are human, leave this field blank.

Background Check Authorization Form

I authorize Blackshirt LLC and Trusted Employees, to conduct a criminal background investigation as part of its volunteer screening and/or selection process. This information in part or in whole will be provided to Blackshirt LLC in the form of a report provided by ADP.

I authorize and consent, without reservation to the retrieval of information that may include but is not limited to organization, federal, state, or county-level agencies, insurance sources, driving, and criminal history.

I certify that all of the statements and answers set forth on the application form are true and complete to the best of my knowledge. I understand that should any statements or answers be found to be false or information has been omitted, such false statements or omissions will be just cause for termination of employment.

Name