Applications

Date *

First Name *

Last Name *

Address *

City *

State *

Zip *

Are you 21 years or older? *

Yes

No

Cell Phone # *

Other Phone# *

Email Address *

Have you ever been convicted of a crime? (misdemeanor or felony) *

Yes

No

(Some convictions may be relevant of the job for which you are applying; It does not automatically bar you from employment)

If yes, please explain. Include date(s) and type of convictiion(s)

Are you legally eligible for employment in the USA? *

Yes

No

(Proof of US Citizenship or immigration status will be required for employment)

Have you ever filled out an application with CareRide? *

Yes

No

Are applying for *

Are you interested in? *

Full Time

Part Time

Starting Salary? ____/hour *

Date available for work at CareRide *

How did you hear about CareRide *

. *

Friend

MTA

Other (Please specify above)

Advertisement (Please specify where above)

If you are applying for a driving position, you MUST complete the above section; Do you have a commercial driver's license?

Yes

No

Issuing State *

License Class *

Expiration Date *

License # *

Do you have passenger endorsement ? *

Yes

No

How many years have you been driving ? *

Have you been involve in an accident while you were driving in the last 5 years? *

Yes

No

If yes, please describe the circumstances, injuries, location and outcome:

Have you ever been convicted of moving violations? *

Yes

No

Date

Offense

City/State

How long have you had your CDL? *

Has your license ever been suspended or revoked? *

Yes

No

If yes, please detail the circumstances, date(s) and time(s)

How often do you use drugs? *

Often

Occsionally

Never

How often do you drink alcohol? *

Often

Occsionally

Never

Have you ever been removed from work at the request of the MTA and/or New York City Transit? *

Yes

No

If yes, please detail the circumstances, date(s) and time(s)

Have you ever taken the Defensive Driving Course? *

Yes

No

If yes, please detail the circumstances, date(s) and time(s)

High School - Name and Location of School *

# of Years Attended *

Did you Graduate *

Yes

No

College - Name and Location of School

# of Years Attended

Did you Graduate

Yes

No

Trade School

# of Years Attended

Did you Graduate

Yes

No

Other

Name of Employer *

Employed From - To *

Address (include city and state) *

Job Title *

Name, Title and contact # of immediate supervisor *

Reason for leaving *

Where you terminated or did you leave on your own? *

Starting Salary *

Ending Salary *

May we contact ? *

Yes

No

Employer's Phone# *

Brief Job Description/Comments *

Name of Employer

Employed From

Employed To

Address (include city and state)

Job Title

Name, Title and contact # of immediate supervisor

Reason for leaving

Where you terminated or did you leave on your own? *

Starting Salary

Ending Salary

May we contact ?

Yes

No

Employer's Phone#

Brief Job Description/Comments

DRIVERS : Additional Information: Please list any additional training, license or qualifications that you may have

SUPERVISORS : Additional Information: Please list any additional training, license or qualifications that you may have

FLEET MAINTENANCE : Additional Information: Please list any additional training, license or qualifications that you may have

OFFICE STAFF : Additional Information: Please list any additional training, license or qualifications that you may have

Aliase: If you were employed under a different name(s), please indicate for the purpose of verifying references

References: Name first person other than relatives or employers, who have knowledge of your work experience *

1. Relationship *

1. Mailing Address (include city and state) *

1. Phone# *

References: Name second person other than relatives or employers, who have knowledge of your work experience

2. Relationship

2. Mailing Address (include city and state)

2. Phone#

Emergency Contact #1 Name

Relationship

Phone#

Emergency Contact #2 Name

Relationship

Phone#

Driver Record Check Form - Name: *

SSN: *

Position Applying For: *

1. I understand that the position I'm applying for requires a valid driver's license and good driving record and that CareRide Paratransit will do a check with the Departmant of Motor Vehicles in order to verify the above.
2. I also understand that employees of CareRide Paratransit who are required to drive a motor vehicle as part of their employment duties will have their Driver's license checked periodically in order to ensure compliance with the above requirements.
3. In addition I am required to immediately notify the Operation Manager should my license be suspended or revoked. In such case, I will not be allowed to operate a motor as part of my employment duties at CarerRide Paratransit.
4. If my primary duty at CareRde Paratransit is to drive a motor vehicle, suspension or revocation of my license for any reason constitutes immediate grounds for termination of my employment by CareRide Paratransit. In addition, failure to notify Careride Paratransit of a suspension or revocation will be grounds for immediate termination.

Initials *

Date *

Certificate of Applicant: I understand that any false statement or willful omissions of fact on this application and any attachments may constitute grounds for rejection of this application or dismissal from employment regardless of when the discovery is made by CareRide. Therefore, I certify that the statements made on this application and attachments are true and complete to the best of my knowledge. I understand that employment at CareRide is at will and I may be discharged at any time without prior notice or cause. I further understand that management employees are at will employees and may be discharged at any time without prior notice or cause. Likewise, I may resign from the agency at any time. I further understand that this application is not intended to be a contract for employment. I hereby authorize CareRide to investigate my references, employment history, educational credentials and other matters related to my suitability for employment. I hereby authorize the references, employers and institutions I have listed, including their employees and representatives, to disclose any information related to my work record, educational record or references. Further, I hereby release the CareRide, my former employers, any reference and any other person or entity from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure and waive the right, if any, to inspect copies of any letter of reference or recommendation. I understand that in accordance with New York State Law, if I am offered employment I may be fingerprinted and that such offer and continued employment are conditional upon satisfactory clearance by the company’s Background investigative division and satisfactory reference verification. All employees and applicants for employment are afforded equal employment opportunities without regard to race, color, religion, sex (except where sex is a bona fide occupational qualification), sexual preference, and disability, age or national origin. CareRide is in compliance with the Americans with Disabilities Act (ADA) of 1992.

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