About
Services
On Demand
Ride
Careers
COVID-19
Contact
Drivers
If you are interested in joining the Dependacare Transportation team, please complete the form below. All applicants will be required to provide a five year motor vehicle record, pass a seven year national background check and drug test. CPR/First Aid certification will be provided once application is processed and approved. Questions marked with an asterisk are required. Thank you for your interest!
BASIC INFORMATION
Name
*
First
Last
Email
*
Phone
*
Address
*
Street Address
Address Line 2
City
ZIP Code
Position Applying For
*
Employee Driver
Independent Contract Driver
Dispatcher
Desired Weekly Salary
*
Date Available to Start
*
What days are you available?
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
(Please check all that apply)
How many hours do you want to work?
*
Full-time
Part-time
(Please check all that apply)
Have you had any accidents in the past three years?
*
Yes
No
If yes, please explain:
Have you had any moving violations in the past three years?
*
Yes
No
If yes, please explain:
Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgement to a felony?
*
Yes
No
If yes, please explain:
I certify that I am a U.S. Citizen, permanent resident, or a foreign national with authorization to work in the United States.
*
Yes
No
EDUCATION
College or University
From
MM
DD
YYYY
To
MM
DD
YYYY
Did you graduate?
Yes
No
Degree
High School
*
Did you graduate?
*
Yes
No
EMPLOYMENT HISTORY
Please list your last three jobs starting with the most recent.
Company
*
Job Title
*
City, State
*
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
List your primary skills & responsibilities:
*
Ending salary/hourly rate?
*
Reason for leaving?
*
Supervisor Name & Title
*
May we contact your supervisor for a reference?
*
Yes
No
Company
Job Title
City, State
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
From
MM
DD
YYYY
To
MM
DD
YYYY
List your primary skills & responsibilities:
Ending salary/hourly rate?
Reason for leaving?
Supervisor Name & Title
May we contact your supervisor for a reference?
Yes
No
Company
Job Title
City, State
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
From
MM
DD
YYYY
To
MM
DD
YYYY
List your primary skills & responsibilities:
Ending salary/hourly rate?
Reason for leaving?
Supervisor Name & Title
May we contact your supervisor for a reference?
Yes
No
REFERENCES
Please provide two references.
Name
*
First
Last
Relationship to you
*
Phone
*
Years Known
*
Name
*
First
Last
Relationship to you
*
Phone
*
Years Known
*
If you have a resume and would like to submit it, please upload it below.
I certify that my answers are true and complete to the best of my knowledge. I understand that any misleading or incorrect statements made on this application or omissions of facts will be considered sufficient cause for denial or termination of employment without any liability to the Company. I authorize Dependacare Transportation to conduct such investigation as may be necessary to verify the information contained in this application and to determine my qualifications for the position for which I am being considered. I authorize the companies, schools, or persons named on this application to give the Company any information regarding my employment, character, and qualifications, together with any information that they may have regarding me whether or not it is in their records. I further understand that an investigative consumer report, including information as to my character, general reputation, personal characteristics, and mode of living, whichever is applicable, may be made, and upon written request by me, within a reasonable period of time, I shall receive a complete and accurate disclosure of the nature and scope of the investigation. I understand that all offers of employment are conditional, subject to the receipt of satisfactory reference and background investigations. If employed, I agree to comply and abide by the rules and regulations of the Company. I recognize my employment will be subject to the conditions of my applicable introductory period or Company policy. I understand that, if employed, my employment relationship with the Company is an at-will relationship, and as such may be terminated at any time by either party. Nothing in the application form, employee handbooks, or policy manuals is intended by the Company to be an express or implied contract of employment or guarantee of employment for a specific period of time between the company and/or me, unless clearly stated and signed by both parties. If employed, I agree to cooperate with any security-related investigations or inquiries deemed necessary by the Company at any time. Except to the extent authorized by the company, I will preserve in strictest confidence any information I have or may acquire regarding any of the Company’s confidential business affairs.
I agree to the above disclaimer.
*
Yes
No
Email
This field is for validation purposes and should be left unchanged.