APPLICATION FOR DRIVERS

In compliance with Federal and State equal opportunity laws, qualified appllicants are considered for all positions without regard to race, color,
religion, sex, national origin, age, marital status, or not-job related disability.


Name: Last First       Date:

Address: Street   City

              State Zip                                               

CDL License Number A B C D E

Passenger Endorsement? Yes No

Home Phone                              Cellular Phone

Email address if applicable

Date of Birth                If applicable referred by

How did you hear about Access-A-Ride

Are you currently employed? Yes No

If yes: may we contact your present employer? Yes No

EDUCATION

Highest grade completed: GED High School Jr. College College

GENERAL INFORMATION

Please describe any special training and skills you have with emphasis on computer / PC experience:


UNITED STATES MILITARY SERVICE: Yes No
If yes - last rank before discharge:

EMPLOYMENT HISTORY
(Start with the most recent employment and work backward)


DATE / MONTH / YEAR
NAME / ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING

FROM
TO

NAME

ADDRESS

FROM
TO

NAME

ADDRESS

FROM
TO

NAME

ADDRESS

References:

Name Company / Title / Phone