Prequalifications:
Which PTI location do you live closest to?	* required	Click here to review our Branch Location List
Please complete the prequalifications section by checking the box next to each true statement:	I have a valid driver's license. I have been driving for at least 7 years. I have not had more than 2 speeding violation in the last 3 years I have not had more than 1 accident in the last 3 years I have not had my license suspended in the last 5 years I have not had my license revoked in the last 5 years
Personal Data
First Name:	* required
Last Name:	* required
Home Phone:	* required
Other Phone:
Street Address:	* required
City:	* required
State:	* required
ZIP Code:	* required
Social Security Number:
Are you legally authorized or permitted to work in the United States?	Yes No
Have you ever been convicted of, or pled guilty to a crime?  (A conviction will not be an absolute bar to an offer of employment)	Yes No
If Yes, explain:
Placement Information
Position:	Driver
Are you interested in:	Full-Time Part-Time
Salary or Wage desired:
Date Available:	* required
Who or what referred you to United Companies?
Have you ever applied or been employed by United Companies before?	Yes No
If Yes, when and where, and under what name:
Are you employed now?	Yes No
If Yes, may we contact your employer?	Yes No
Can you perform the essential functions of the job for which you are applying with or without reasonable accomodation?  (If you have any question about the job's functions, please ask the interviewer before answering the question.)	Yes No
Education Record
List last high school and all business, trade schools and colleges attended
Name and Location of School	Major/Minor	Degree	Graduated
High School			Yes	No
College
Business/Trade
Other
Employment History
List all employers with current or most recent employment first.  Leave no time unaccounted for, include military service.  If limited previous employment, list three persons, not related, who have known you for some time.
Present/Last Employer Address Position Title	Telephone Number Dates Employed Date of Last Wage Increase	Supervisor's Name Starting Base Salary or Wage Ending Salary or Wage
Summary of Duties	Reason for Leaving
First Previous Employer Address Position Title	Telephone Number Dates Employed Date of Last Wage Increase	Supervisor's Name Starting Base Salary or Wage Ending Salary or Wage
Summary of Duties	Reason for Leaving
Next Previous Employer Address Position Title	Telephone Number Dates Employed Date of Last Wage Increase	Supervisor's Name Starting Base Salary or Wage Ending Salary or Wage
Summary of Duties	Reason for Leaving
Next Previous Employer Address Position Title	Telephone Number Dates Employed Date of Last Wage Increase	Supervisor's Name Starting Base Salary or Wage Ending Salary or Wage
Summary of Duties	Reason for Leaving
Occupational References
List below three persons, not related to you, who know about your work.
1. Name Address (Street, City, State, Zip Code) Telephone		Occupation/Company Years Acquainted
2. Name Address (Street, City, State, Zip Code) Telephone		Occupation/Company Years Acquainted
3. Name Address (Street, City, State, Zip Code) Telephone		Occupation/Company Years Acquainted
UNITED COMPANIES DOES NOT DISCRIMINATE IN HIRING OF TERMS OR CONDITIONS OF EMPLOYMENT ON THE BASIS OF RACE COLOR, CREED, RELIGION, SEX, NATIONAL ORIGIN, AGE, OR ANY OTHER BASIS UPON WHICH DISCRIMINATION IS PROHIBITED BY THE MUNICIPAL, STATE, OR FEDERAL LAW.  NO QUESTION ON THIS APPLICATION IS INTENDED TO SECURE INFORMATION TO BE USED FOR SUCH DISCRIMINATION. IMPORTANT, READ BEFORE SIGNING The filing of an application with United Companies is a preliminary step to employment.  It does not obligate United Companies to offer employment, or the applicant to accept employment.  An offer of employment, if made, is for employment at will and is not to be construed as a guarantee of continued employment.  The first 90 days of employment is considered an introductory (“probationary”) period during which an employee may resign or be released without a stated reason and without regard to any progressive disciplinary steps.  However, United Companies reserves the right to terminate the employment of any employee at any time.  Any employee also has the right to terminate his or her employment with United Companies at any time.    NOTICE TO APPLICANTS AS REQUIRED BY THE FAIR CREDIT REPORTING ACT.  As part of employment process, an investigative consumer report may be prepared regarding an applicant's character, general reputation, personal characterisitics, and mode of living.  Additional information as to the nature and scope of such as report, if made, will be provided upon the applicant's written request. I authorize investigation of all matters contained in this application which United Companies may deem relevant to my employment and authorize my previous employers or other persons having information concerning me or my record to report such information to United Companies and such persons are hereby released from all liability for issuing such information.  United Companies will keep all such information confidential except where such information is required to be released by law or order of a court or other authority.  I understand and agree that I will be subject to immediate dissmissal if it is subsequently discovered that the information contained herein is untrue or that I have failed to disclose a material fact.  I understand that if employed by United Companies, such employment will occur at will and no contract of employment, express or implied is created and that no repsentative of United Companies has any authority to enter into any agreement for employment of any specific period of time, or to make any agreement contrary to the foregoing.  I understand that if I receive an offer of employment and I accept the position, I will be required to complete additional information necessary for company record keeping requirements.
Digital Signature To digitally sign your application:   - Simply enter your full name and the current date in the boxes below - Check the consent box Full Name  * required Date (MM/DD/YYYY)  * required I hereby provide my consent to release the information contained in this form