Full Name
Date of Birth
Phone
Email
Address
City
State
ZIP
Driver's License #
Exp
Position Applied For
NEMT Driver
Date Available to Start
Desired Employment Type Full-TimePart-TimeContractor
Previously worked for MARE Transportation? YesNo If yes, when?
Any accidents/violations in past 3 years? YesNo If yes, describe
Convicted of DUI/reckless driving? YesNo If yes, provide date(s)
Medically cleared to drive and lift passengers? YesNo
Previous Employer
Position Held
From
To
Reason for Leaving
Reference Name & Phone
Upload Resume (PDF, DOC, or DOCX, max 5MB)
I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false statements or omissions may disqualify me from employment or result in termination if discovered after hire.
I authorize MARE Transportation Inc. to conduct background checks, verify driving records, and contact previous employers and references as part of the hiring process.
I agree to the above terms.
Applicant Signature
Date
