Smart Medical Transport - Job Application

Yes

All employees are required to submit to a background check and drug test. If hired to work for Smart Medical Transport, will you be willing to submit to a background check and also complete a drug test?YesNo
PLEASE NOTE: It is important that you complete all parts of the application. If your application is incomplete or does not clearly show the experience and/or training required, your application may not be accepted. If you have no information to enter in a section, please write N/A.
Name (First, MI, Last)
Social Security Number
Mailing Address
City, State, and Zip Code
Telephone
Alternate Phone
If under 18, please list age
Email
example@example.com
Days/hours available to work

I have noMon.Tues.Wed.Thurs.Fri.Sat.
Sun.
I am seeking a

Full-time jobPart-time jobFull- or Part-time
I am seeking a
Can you work nights?
How many hours can you work weekly?
Date available to begin

MonthDayYear
Date
Have you ever been employed by this organization in the past?

YesNo
I certify that I am a U.S, citizen, permanent resident, or a foreigh national with authorization to work in the United States.

YesNo
Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgement to a felony?

YesNo
If Yes, please explain
Do you have a driver's license?

YesNo
Driver's license number
Issued in what state?
Have you had any accidents during the past three years?
How many?
Have you had any moving violations during the past three years?
How many?
College or Business/Trade School
Have you even been in the Armed Forces?

YesNo
Date entered

MonthDayYear
Date
Are you now a member of the National Guard?

YesNo
Discharge date

MonthDayYear
Date
Specialty
Please list ALL work experience beginning with your most recent job held. Attach additional sheets if necessary.
Company
Name of last supervisor
Hrs/week
Address
Start Date

MonthDayYear
Date
Starting Salary
City, State, and Zip Code
End Date

MonthDayYear
Date
Final Salary
Phone number
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
May we contact this employer?

Yes
Company
Name of last supervisor
Hrs/week
Address
Start Date

MonthDayYear
Date
City, State, and Zip Code
End Date

MonthDayYear
Date
Phone number
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Please include name, phone number, and circumstances of your acquaintance. Exclude relatives and former employers.
I certify that all answers and statements on this application are true and complete to the best of my
knowledge. I understand that, should this application contain any false or misleading information, my application may be rejected or my employment with this company terminated.
Should be Empty: