For Official Use Only Date Received:, 2013 Reviewed by: Comments: INTERVIEWED BY: TRAINING RIDEALONG: SUBMITTED MVR TO INSURANCE: DATE: MVR QUALIFY?: EMPLOYMENT/CONTRACTOR APPLICATION Payback Repo Inc. dba P R I provides equal employment opportunity to all qualified persons, and does not unlawfully discriminate against any person on the basis of race, color, creed, religion, sex, national origin, age, disability, marital or veteran status, sexual orientation, criminal or any other legally protected status. Please - Complete all items on the application, even if the information is included on your resume or other document submitted by you. All sections must be completed BEFORE your interview or you will not be considered for hire. Sign/AGREE and date your application and every section of this application. When filling out PDF application agreeing to each section will serve as your signature Specify the exact title of the position in which you are interested. Have your driver s license out ready to be photocopied when you come in with your paperwork. FILL OUT ALL EMPLOYMENT FORMS EVEN THOUGH THIS IS JUST AN INTERVIEW ALL EMPLOYMENT FORMS MUST BE SIGNED EITHER BY PRINT OR ELECTRONIC AND COMPLETED. FAILURE TO DO SO WILL RESULT IN YOUR IMMEDIATE DISSMISAL AND DISQUALIFICATION OF THE INTERVIEW PROCESS. THERE ARE INSTRUCTIONS ON EVERY SECTION WHEN FILLING OUT ELECTRONICALLY YOU MUST FILL OUT THE ELECTRONIC FORM AND SAVE AND EMAIL BACK 1 COPY TO: priemployment@gmail.com BRING IN COMPLETED FORM WITH YOU TO THE INTERVIEW Position Applying For: office customer service rep repossession agent driver/yard/helper license plate scanner field investigator skip tracer intern
Personal Information Name (Last, First Middle) Social Security # Driver s License (State/No.) Address (Street) Best Telephone Number Emergency Contact: Address (City, State, Zip Code) Email relationship: General Information Are you legally eligible for work in the U.S.A.? Have you ever applied to or worked for PRI before? If so, when? Are any of your relatives OR friends currently working for PRI? If so, please list name and department, if applicable: Have you ever been convicted of a felony? If yes, please explain. Are you available to work any shift available? Employment Request What hours can your work? What is the earliest date you can begin work? How did you hear about this position? Unemployment Recruiter Craigslist Company Website Current PRI Employee Employment History *Please begin with most recent employment May we contact your current and or past employers? Employer: Employer:
Employer: Education School Name Location Course of Study Degree Obtained High School/GED College/University Graduate School Vocational / Specialized Military Military Service: Position(s): Specialized Training: References Name Company Title Contact Information Signature / Certification By agreeing I certify that the facts set forth in this application are true, complete, and correct to the best of my knowledge. I understand that any misrepresentations, falsifications, or omissions on this application can be grounds for rejection of my application or, if I am employed or hired by PRI, for my immediate termination from employment. I authorize Payback Repo Inc. d.b.a. PRI to make any necessary inquiries and investigations into my education, military, or employment history. I further authorize, unless otherwise indicated on this application, the release of my information to authorize Payback Repo Inc. d.b.a. PRI by any of the agencies, schools, services, or employers listed on this application. Type Name: Date:
RELEASE OF INFORMATION I,, authorize PRI, to conduct a background investigation in order to assess my eligibility for a position requiring a high level of reliability and trustworthiness. I authorize all persons who may have information relevant to this investigation to disclose it to PRI or their agents. I understand that the investigation may include but not limited to: verification of past employment, education, residential history, psychological make-up, criminal record check, financial condition, opinions of reference and Department of Motor Vehicles search. I authorize any third party to provide PRI with any and all data related to my background. I authorize any third party to verbally discuss my background with PRI. Tests can be done whenever PRI wishes. I release all persons from liability on account of such disclosures. I authorize PRI to conduct random drug tests prior and during my involvement with PRI. I hold PRI or their agents harmless specific to disclosure of my background. I fully understand the statements above and have no issue with the release of information. Applicant Signature Print Name Date
Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-9 OMB No. 1615-0047 Expires 03/31/2016 START HERE. Read instructions carefully before completing this form. The instructions must be available during completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) they will accept from an employee. The refusal to hire an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.) Last Name (Family Name) First Name (Given Name) Middle Initial Other Names Used (if any) Address (Street Number and Name) Apt. Number City or wn State Zip Code Date of Birth (mm/dd/yyyy) U.S. Social Security Number - - E-mail Address Telephone Number I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. I attest, under penalty of perjury, that I am (check one of the following): A citizen of the United States A noncitizen national of the United States (See instructions) A lawful permanent resident (Alien Registration Number/USCIS Number): An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy) (See instructions). Some aliens may write "N/A" in this field. For aliens authorized to work, provide your Alien Registration Number/USCIS Number OR Form I-94 Admission Number: 1. Alien Registration Number/USCIS Number: OR 2. Form I-94 Admission Number: 3-D Barcode Do Not Write in This Space If you obtained your admission number from CBP in connection with your arrival in the United States, include the following: Foreign Passport Number: Country of Issuance: Some aliens may write "N/A" on the Foreign Passport Number and Country of Issuance fields. (See instructions) Signature of Employee: Date (mm/dd/yyyy): Preparer and/or Translator Certification ( be completed and signed if Section 1 is prepared by a person other than the employee.) I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct. Signature of Preparer or Translator: Date (mm/dd/yyyy): Last Name (Family Name) First Name (Given Name) Address (Street Number and Name) City or wn State Zip Code Employer Completes Next Page Form I-9 03/08/13 N Page 7 of 9