Your Name: (required) * Your Email: (required) * Phone: * Driver's License Number: * Over 21?: * Select Your Answer Yes No Are you legally allowed to work in the country?: * Select Your Answer Yes No Are you currently employed?: * Select Your Answer Yes No Current Employer: May we contact your current employer?: Select Your Answer Yes No Are you currently on layoff status and subject to recall? : * Select Your Answer Yes No What date are you available to work?: * Are you able to travel if the job requires it? : * Select Your Answer Yes No Have you been convicted of a Felony or Misdemeanor in the last 7 years? : * Select Your Answer Yes No If yes, please explain: Are you physically or otherwise unable to perform the duties of the job you are applying for? * Select Your Answer Yes No Previous Employment (Please list past ten years of employment history): * Please list special skills and qualifications: * Please list 3 (three) professional references: Include name and contact information * Type of Employment Desired: * Select Your Answer Full-Time Part-Time Seasonal Casual Position Desired: * Select Your Answer Paratransit Driver EMT Paramedic Clerical Billing Dispatch Admin How did you hear about us? Search Engine (Google, Yahoo, etc.) Radio Recommended by a friend or colleague Social Media Other Additional Information: Please read and acknowledge the following:
I certify herein that the answers are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
The Applicant understands that neither this document or any offer of employment from MED-VAN TRANSPORT constitutes an employment contract unless a specific document to that effect is agreed to by the employer and the employee in writing.
In the event of employment, I understand that false or misleading information given in my application or interview may result in immediate discharge. Furthermore, I understand I am required to abide by all rules and regulations of MED-VAN TRANSPORT.
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