• Royal Haven Mobility Driver Application

    Standard online application form for Royal Haven Mobility Driver applicants. Use the original field labels as extracted from the referenced PDF.

  • Applicant Information

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Eligibility and Program Interest

  • Legally authorized to work in the United States*
  • At least 18 years old*
  • Program interest*
  • Comfortable transporting ambulatory passengers*
  • Royal Companion Service comfort level*

  • Driver License Information

  • Driver's License Expiration Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Driver's License Currently Valid and Unrestricted*
  • Any Driver's License Suspension, Revocation, or Cancellation*

  • Driving History

  • Moving violations or citations in the past 5 years*
  • Motor vehicle accidents in the past 5 years*
  • History of DUI/DWI or similar impaired-driving offense*

  • Professional Experience

  • Previously worked as a professional driver?*
  • Experience in NEMT/medical transportation, rideshare, paratransit, shuttle, caregiving, healthcare, or companion services?*
  • May Royal Haven contact this employer or reference?*

  • Availability and Scheduling

  • Days Available*
  • General Availability*
  • Available for Occasional Weekend Assignments*
  • Willing to Accept Trips Requiring Wait Time for Passenger Appointments*

  • Job Requirements and Training

  • Willing to operate company-provided vehicle and follow policies*
  • Comfortable assisting passengers with entering and exiting the vehicle*
  • Able to provide professional, patient, respectful service to diverse passengers*
  • Willing to maintain passenger privacy and complete confidentiality/HIPAA training*
  • Willing to use the company-required mobile app, GPS, dispatch, or trip-verification system*
  • Current training and certifications
  • Willing to complete orientation and training before transporting passengers*
  • Willing to provide information for MVR/driving-record review*
  • Willing to complete background, registry, exclusion, and credential screening*
  • Willing to complete drug and alcohol testing if required*

  • References

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Applicant Declaration

  • Application Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Internal Review

  • Application Status*
  • MVR Review Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: