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About Us
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Contact
SCHEDULE A RIDE

NEMT Job Applicationadmin2022-12-22T00:30:43-08:00

NEMT Job Application

- Step 1 of 7

Personal Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Number

Cell Number *

Email *

Are you eligible to work in the United States? *

Yes
No

Do you have a current Portland NEMT Permit? *

Yes
No

When does your NEMT Permit expire?

Have you been convicted of or pleaded no contest to a felony within the last Ten years? *

Yes
No

If you have been convicted, please explain.

Do you have an excellent driving record? *

Yes
No

If no, please explain.

Position Availability

Please select and explain your availability for each day of the week below. Your shift will be a minimum of 10 hours between 4AM and 5PM (Start and end times will change Daily)

Monday Availability *

Always Available 4AM-5PM*
Limited Availability ( Please Explain)

*required to work a Minimum of 10 Hours per shift

Please Explain your Limited Availability *

Tuesday Availability *

Always Available 4AM-5PM*
Limited Availability ( Please Explain)

*required to work a Minimum of 10 Hours per shift

Please Explain your Limited Availability *

Wednesday Availability *

Always Available 4AM-5PM*
Limited Availability ( Please Explain)

*required to work a Minimum of 10 Hours per shift

Please Explain your Limited Availability *

Thursday Availability *

Always Available 4AM-5PM*
Limited Availability ( Please Explain)

*required to work a Minimum of 10 Hours per shift

Please Explain your Limited Availability *

Friday Availability *

Always Available 4AM-5PM*
Limited Availability ( Please Explain)

*required to work a Minimum of 10 Hours per shift

Please Explain your Limited Availability *

Saturday Availability *

Always Available 4AM-5PM*
Limited Availability ( Please Explain)

*required to work a Minimum of 10 Hours per shift

Please Explain your Limited Availability *

Sunday Availability *

Always Available 4AM-5PM*
Limited Availability ( Please Explain)

*required to work a Minimum of 10 Hours per shift **We normally do not operate on Sundays

Please Explain your Limited Availability *

Notes / Pre-planned Vacations

Tell us about any other preferences regarding work days or times.

Are you flexible with working hours? *

Yes
No

Are you open to working overtime? *

Yes
No
Preferred
Not Preferred

Date you are available to start work: *

Education

School *

Name and Address of School - Degree / Diploma - Graduation Date

Skills & Qualifications *

Licenses, Skills, Training, Awards, etc.

Employment History

Are you currently employed? *

Yes
No

Current Employer *

City *

Start Date *

End Date

Supervisor *

First

Last

Phone *

Email

Position Title *

Responsibilities: *

Reason for Leaving (if applicable)

May we contact your current employer? *

Yes
No

Employment History (continued)

Have you previously been employed? *

Yes
No

Previous Employer *

City *

Start Date *

End Date *

Supervisor *

First

Last

Phone *

Email

Position Title *

Responsibilities *

Reason For Leaving *

Professional Reference

Please provide a professional reference.

Name - Professional Reference *

Title *

Phone *

Personal Reference

Please provide a personal reference.

Name - Personal Reference *

Relationship *

Phone *

Agreements

Company Drug Policy (Drug Testing): On the basis of the requirements through State and local mandates, as well as contractual agreements SMT has with their clients and or brokerage firms, I agree to drug testing prior to my employment, as well as random drug testing, to include immediate drug testing if I am involved in any accident or incident during the course of my employment with SMT. *

I Agree

Information Validity: I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I agree to and authorize the verification of all information listed above. *

Signature

Comment

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