Chauffeur Application
Disclosure and Authorization to Release Information

First Name

Fax your resume to:
617-904-1763
Middle
Last Name
Address
City State
Zip Phone
E-Mail
Date of Birth Social Security#
Position applying for:

_________________________________________________________________________

Driver's License Number

State

  
License Expiration Date

CDL?
No. of Tickets the last 3 years
No. of Accidents last 3 years
DUI? If yes, when
License suspended or revoked? If yes, when
Attended Driving School School Name
Have you ever been convicted of a criminal misdemeanor? If yes, when and what?
Have you ever been convicted of a felony? If yes, when and what?
Are you currently serving in the military?  What is your separation date?

___________________________________________________________________________
Employment History

Dates of Employment:

From To
Employer's Name Address
City State
Phone Position
Reason for leaving

__________________________________________________________________________

Dates of Employment:

From To
Employer's Name Address
City State
Phone Position
Reason for leaving

___________________________________________________________________________

Dates of Employment:
From To
Employer's Name Address
City State
Phone Position
Reason for leaving

___________________________________________________________________________

Finally, bring with you the following to our office at the time of your interview:
1.  Driver's License.
2.  Social Security Card.
3.  Copy of your Current DMV record.

I understand that in processing my application with “Boston Limousine”, an investigation may be made in which information is obtained through a review of information held by law enforcement or other government agencies. I authorize you to verify my past employment and education, criminal convictions/personal references, and other job related data provided on this application, or via the interview process. I authorize the appropriate individuals, companies, institutions, or agencies to release them from any liability as a result, of such inquiries of disclosures. A report my be generated summarizing this information.

I further understand and waive my right of privacy in this investigation and release and hold harmless Boston Limousine, it's agents, employees, assigns, divisions or affiliates from any and all liability relating to Boston Limousine's investigation.

I agree that any decision to hire me is contingent upon the results of my report and certify that all statements and answers on my application, resume , or interview are true and complete to the best of my knowledge.  I understand that if any statements are found to be false or that if information has been omitted, this will be cause for disqualification and immediate termination of my work contract.