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SCHEDULE A RIDE
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Home
About Us
Services & Fees
Careers
FAQ
Contact
SCHEDULE A RIDE
NEMT Job Application
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2022-12-22T00:30:43-08:00
NEMT Job Application
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Step
1
of 7
Personal Information
Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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.
Next
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:
*
Back
Next
Education
School
*
Name and Address of School - Degree / Diploma - Graduation Date
Skills & Qualifications
*
Licenses, Skills, Training, Awards, etc.
Back
Next
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
Back
Next
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
*
Back
Next
Professional Reference
Please provide a professional reference.
Name - Professional Reference
*
Title
*
Phone
*
Personal Reference
Please provide a personal reference.
Name - Personal Reference
*
Relationship
*
Phone
*
Back
Next
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
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