Career Opportunities

Empire Caring Transit Corp is an equal opportunity employer and consider all applicants for all positions without regard to race, color, religion, gender, national origin, marital or veteran status, or any disability as provided in the Americans with Disabilities Act.**

Date of Application: *

Personal:

First Name: *

Middle Initial:

Last Name: *

Street Address:

Apt/Ste:

City: *

State: *

Zip code: *

Telephone Number(s)

Home:

Cell: *

Email: *

Best Time to Contact You:

SSN #:

Do you have a current Driver’s License?

Yes

If yes, Number: Type:

Employment Desired:

Work History:

List names of employers in consecutive order with present or last employer first. Account for all periods of time, military service, and any periods of unemployment. If self-employed, give firm name and supply business reference.

Name of employer:

Address:

City:

State:

Zip code:

Phone number:

Supervisor:

Dates of Employment:

Duties:

Reason for leaving:

Name of employer:

Address:

City:

State:

Zip code:

Phone number:

Supervisor:

Dates of Employment:

Duties:

Reason for leaving:

Name of employer:

Address:

City:

State:

Zip code:

Phone number:

Supervisor:

Dates of Employment:

Duties:

Reason for leaving:

Education:

Highschool:

Name:

Address:

Graduated:

Yes

Course studies:

Undergraduate College:

Name:

Address:

Graduated:

Yes

Course studies:

Graduate Professional:

Name:

Address:

Graduated:

Yes

Course studies:

Describe any specialized training, apprenticeship, skills, and extra-curricular activities:

Military:

Have you ever served in the Military:

Yes

If yes, Service Branch:

Date Entered:

Date Separated:

Capability & Reliability:

Would you be able to perform all the tasks required by the job you are applying for?:

Yes

If not, which tasks:

Would you be willing and able to report to work every day on a constant basis? If no, please explain:

Will you abide by the safety rules of Empire Caring Transit Corp:

Have you had any traffic violations?:

Yes

Have you ever been convicted of any crimes (excluding minor traffic violations) including DUI?:

Yes

If yes, state offense(s), location, and date of disposition: Note: A conviction will not necessarily disqualify you from employment.

Supplemental Employment Skills:

If you worked in any of your positions under another name, please provide the Name(s):

Are you presently employed:

Yes

If yes, may we contact your present employer:

Yes

Have toy been fired or asked to resign from a job:

Yes

If yes, please explain:

Professional Information:

List any professional licensing or certification you have with expiration dates:
State of Florida EMT Basic/Intermediate/Paramedic

BLS/ACLS/PALS Provider:

First Aid/ CPR:

References:

Please provide us (3) references that have no relation to you

Name:

Address:

City:

State:

Zip:

Occupation:

Name:

Address:

City:

State:

Zip:

Occupation:

Name:

Address:

City:

State:

Zip:

Occupation:

AFFIDAVIT:

I certify that all answers to the foregoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading, or otherwise incorrect statements made on this application form, or during any interview may ne grounds for immediate discharge.

I hereby authorize Empire Caring Transit Corp to contact any organizations or individual it deems appropriate to investigate on my employment history, character and qualifications. I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. In addition, I hereby give my right to bring any cause of action against these individuals for defamation, invasion of privacy, or any other reason because of their statements.

I agree that if i am employed, I will abide by all the rules and regulations of Empire Caring Transit Corp. I understand tat drug an alcohol testing when given pursuant to Empire Caring Tran sit Corp policy, are a condition of continued employment and that refusal to take such test when asked will be grounds for: (1) refusal to hire; ) immediate termination; or, (3) immediate suspension or a period of time as determined by the Program Director, during which such suspension the employee will be required to undergo appropriate treatment.

I further understand that my employment is “at will” and may be terminated by Empire Caring Transit Corp, at any time for reason, at will, and with or without prior notice.

Signature *

Date *

Personal:

Telephone Number(s)

Employment Desired:

Work History:

Education:

Highschool:

Undergraduate College:

Graduate Professional:

Military:

Capability & Reliability:

Supplemental Employment Skills:

Professional Information:

References:

AFFIDAVIT:

Contact Info

Hours

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