Employment Application

Please Fill Out All Required Fields

1Basic Info

2Education

3References

4Previous Employment

5Military Service

6Misc. Questions

7Misc. Questions 2

8Submit

Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

When Can You Start?(Required)

MM slash DD slash YYYY

Desired Position(Required)

Did you attend high school?

High School Name

High School Years Attended (ie 2001-2005)

Did You Graduate?

Yes

Degree

Did You Attend College?

Yes

College Name

College Years Attended (i.e. 2005-2008)

Did You Graduate?

Yes

Degree

Please Describe Any Additional Education

Text Example

Please provide three professional references.

1st Reference - Full Name(Required)

Relationship(Required)

Company(Required)

Phone(Required)

Address(Required)

2nd Reference - Full Name(Required)

Relationship(Required)

Company(Required)

Phone(Required)

Address(Required)

3rd Reference - Full Name(Required)

Relationship(Required)

Company(Required)

Phone(Required)

Address(Required)

Company

Phone

Address

Supervisor

May We Contact Your Previous Supervisor For A Reference?

Yes

Job Title

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Job Responsibilities

Reason For Leaving

Company

Phone

Address

Supervisor

May We Contact Your Previous Supervisor For A Reference?

Yes

Job Title

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Job Responsibilities

Reason For Leaving

Text Example

Military Service

Branch

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Rank At Discharge

Type Of Discharge

If other than honorable, please explain...

Do You Hold A Current (Class D) Drivers License?(Required)

Yes

License Number(Required)

U.S. States(Required)

Are you 25 years of age or older?(Required)

Yes, I am at least 25 year of age

No, I am younger than 25 years

To be employed as a medical transport driver, you must be 25 or above.

Have You Ever Worked For iRide Medical Transport?

Yes

If So, When?

In order to permit a check of your work and education records, should we be made aware of any name that you previously used?

Yes

If "yes", identify name(s) and relevant dates.

Text Example

The following question is asked pursuant to the immigration reform and control act of 1986.

Are you authorized to work legally in the United States?(Required)

Yes

Text Example

The following information will be considered only insofar as it is relevant to the job for which you are applying.

A "yes" answer will not automatically disqualify you from consideration.

Have you ever been arrested or convicted of a crime?(Required)

Yes

If "yes", list nature of the crime, date of arrest or conviction and city and state:

Text Example

Note: You are not required to disclose the existence of any arrest, criminal charge or conviction, the records of which have been erased pursuant to Connecticut General Statutes Sections 46b-146, 54-76o or 54-142a. Criminal records subject to erasure pursuant to Connecticut General Statutes Sections 46b-146, 54-76o or 54-142a are records related to: (a) determinations of “delinquency” or that, as a child, you were a member of a family with service needs, (b) a ruling you are a “youthful offender”, (c) a finding you are not guilty for a criminal charge, or (d) a conviction for which you have received an “absolute pardon.” Any person whose criminal records have been erased pursuant to Connecticut General Statutes Sections 46b-146, 54-76o or 54- 142a shall be deemed to have never been arrested within the meaning of the general statutes with respect to the proceedings so erased and may so swear under oath.

Text Example

Applicant's Statement

I hereby affirm that the information I have provided on this application and in the interview and selection process is true and complete to the best of my knowledge. I also agree that any falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for my dismissal if discovered at a later date.>

I authorize a thorough investigation of my past employment and activities, I agree to cooperate in such investigation, and I hereby release from all liability and responsibility all persons and corporations requesting or supplying such information to M7.>

I hereby agree that any offer of employment may be subject to the results of a pre-employment physical examination by a qualified medical practitioner; the negative results of a criminal background check for criminal convictions not disclosed above; and/or the negative results of a urinalysis drug test.>

I understand that if I become employed by M7, it shall be a condition of employment that I abide by the company’s policies and requirements, including a requirement to enter into an arbitration agreement. I agree that any employment that results from this application shall be at will. If I become employed I may terminate my employment relationship with m7 at any time and for any reason, or for no reason, with or without notice, and M7 has the same right.

I understand that initialing below counts as my signature.

Your Initials(Required)

Today's Date(Required)

MM slash DD slash YYYY

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