IATIA Enterprises Application

IATIA Medical Courier Driver Application

Please complete the job application below in its entirety to be considered for employment with IATIA Enterprises, Inc. Be sure to provide accurate and up-to-date information, as this will help us review your qualifications efficiently. Once submitted, our team will carefully evaluate your application and contact you if your experience aligns with our current opportunities.
Applicant Information
Full Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City / State / ZIP
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Date of Application

MonthDayYear
Date
Position Applying For
Valid Driver's License
Driver's License Number
State Issued
Driver's License Expiration Date

MonthDayYear
Date
Insurance Provider
Background Information
Policy Number
Felony Conviction History
Compliance, Background Check & Drug Screening Consent
I understand and agree that employment with IATIA Enterprise Inc. is contingent upon the following:
- Successful completion of required training
- Consent to and passing a background check
- Consent to and passing a drug screening
I authorize IATIA Enterprise Inc. to conduct a background investigation and drug testing as part of the hiring process.
If Yes, Please Explain
Availability
Applicant Initials
Days Available
Hours Available
Employment History

(Please list your last three employers)
Company Name #1
Job Title
Rate of Pay
Supervisor Name
Reason For Leaving
Job Description
Company Name #2
Job Title
Rate of Pay
Supervisor Name
Reason For Leaving
Job Description
Company Name #3
Job Title
Rate of Pay
Supervisor Name
Reason For Leaving
Job Description
Availablity
Can You Work Weekends / Holidays
References
Reference 1 Name

First NameLast Name
Reference 1 Relationship
Reference 1 Company
Reference 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 Email Address
example@example.com
Reference 2 Name

First NameLast Name
Reference 2 Relationship
Reference 2 Company
Reference 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 Email Address
example@example.com
Reference 3 Name

First NameLast Name
Reference 3 Relationship
Reference 3 Company
Reference 3 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3 Email Address
example@example.com
EMPLOYMENT VERIFICATION AUTHORIZATION
I hereby authorize IATIA Enterprise Inc. and its representatives to contact my previous employers listed on my application for the purpose of verifying my employment history, including but not limited to dates of employment, positions held, compensation, job performance, and reason for separation.

I authorize all former employers, supervisors, and references to release such information and hold them harmless from any liability arising from the disclosure of this information.

This authorization remains valid for the duration of the hiring process unless revoked in writing.
Applicant Name (Print)
Applicant Signature
Signature
Additional Information
Relevant experience
If yes, please explain
Applicant signature
Date

MonthDayYear
Date
For Office Use Only
Employment Verification Date

MonthDayYear
Date
Interview Date

MonthDayYear
Date
Interviewer Name
Notes
Hiring Decision
Should be Empty:

IATIA Medical Courier Driver Application

Applicant Information

Background Information

Compliance, Background Check & Drug Screening Consent

Availability

Employment History

Availablity

References

EMPLOYMENT VERIFICATION AUTHORIZATION

Applicant Signature

Additional Information

For Office Use Only