Driver Application

  • DRIVER APPLICATION

    Please give complete answers to ALL questions - Incomplete answers will only slow, or stall the application and our goal is to get you hired quickly.

  • General Information

  • Were you at this address 10 years or more*
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  • Have you ever been known by any other name?
  • If hired, can you furnish proof you are eligible to work in the U.S.?*
  • Are you between the ages of 25 and 75?*

  • License Information

  • Have you held a VALID US license for the past 36 months?*

  • Additional Information

  • Have you had any moving violations in the last 5 years?*
  • Has your license ever been suspended?*
  • Have you had any accidents in the last 5 years?*
  • Have you ever had a DUI, DWI, or OVI?*
  • Have you ever been convicted of a felony?*
  • Have you ever been convicted of a misdemeanor?*

  • EMPLOYMENT HISTORY

  • Please list your last three (3) jobs, starting with the current, or most recent employment first.

  •  -
  • Is this your current employer?*
  • May we contact this employer at this time?*
  • Was this a driving position?

  • NEXT EMPLOYER

  •  -
  • Was this a driving position?

  • NEXT EMPLOYER

  •  -
  • Was this a driving position?

  • Education

  • Did you graduate?
  • Did you graduate?

  • Official Disclosure Statement

    I certify that I personally completed this application and that all of the information is true and correct to the best of my knowledge.

    Authorization to Release Records

    I authorize Accessible Care Transport, Inc. to do a complete background investigation in accordance with state and federal laws. I authorize my previous employers to release any information requested by Accessible Care Transport, Inc. and hold them harmless of all liability from the release of said information. 

    I hereby authorize for cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold harmless of all liability all companies, agents and associated parties for the use of this application.

  • Choose ONE:*
  • Should be Empty: