EMPLOYMENT APPLICATION

PERSONAL INFORMATION

Full Name

Application Date

Street Address/Apt No.

City

State

Zip

*Phone Number

Cell Phone

*Email

Date of Birth

Social Security Number

Languages Spoken

EMERGENCY CONTACTS/MEDICAL INFORMATION

Name

Relationship

*Phone Number

Name

Relationship

*Phone Number

DRIVING HISTORY

Name as it appears on license

State Issued

License Number

License Expiration Date

Do you have a car?

Yes

If yes License Plate #

Have you had a traffic accident or violation within the past 5 years?

Yes

If yes Explain

PROFESSIONAL SKILLS

Employer # 1 Name

Name

How Long

*Phone Number

Position

Street Address/Apt No.

City

State

Zip

Employer # 2 Name

Name

How Long

*Phone Number

Position

EDUCATION/CERTIFICATIONS

College, Training or Other Certifications

Name

State

Degree

Certification

Year

Name

State

Degree

Certification

Year

Name

State

Degree

Certification

Year

PERSONAL REFERENCES

Name

Relationship

*Phone Number

Name

Relationship

*Phone Number

CHILD CARE EXPERIENCE

What age group (s) do you have experience with? Check all that apply

Pre-School

School Age

Teenagers

Elderly

APPLICANT CERTIFICATION

I certify that the answers and other information on this application are true and correct to the best of my knowledge. Additionally, I understand that misrepresentation or false or fraudulent information on or related to this information may be grounds for disqualification from the hiring process as well as potential termination if hired.

Digital Signature

Date

Saferide Transportation Service does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, age, genetics information, disability, or status as a protected veteran. The Company’s nondiscrimination policy applies to all phases of its employment process and to all other aspects of its transportation programs and activities.Thank youfor choosing Saferide Transportation Service! We appreciate you taking the time to fill out this application.

Job-Application

We appreciate you taking the time to apply. We are currently in the process of taking applications and anticipate beginning interviews

EMPLOYMENT APPLICATION

PERSONAL INFORMATION

EMERGENCY CONTACTS/MEDICAL INFORMATION

DRIVING HISTORY

PROFESSIONAL SKILLS

Employer # 1 Name

Employer # 2 Name

EDUCATION/CERTIFICATIONS

College, Training or Other Certifications

PERSONAL REFERENCES

CHILD CARE EXPERIENCE