Contact Us/Apply Now Get In Touch With Us For Inquiries and Information 5481 State Rd. Parma, Ohio 44134, US admin@trans-assist.com +1 (216) 801-4700 Send Us a Message Name(Required) Phone(Required)Email(Required) MessagePhoneThis field is for validation purposes and should be left unchanged. Job Opportunities Employment Application Step 1 of 6 16% Today’s Date: MM slash DD slash YYYY APPLICANT INFORMATIONName First Middle Last Address Street Address Apartment # City State / Province / Region ZIP / Postal Code Daytime PhoneAlternate PhoneE-Mail Address (Optional) Social Security Number: Ohio Drivers License Number: Position Applied For: Date Available: MM slash DD slash YYYY Desired Salary: $ Are you a Citizen of the United Sates? Yes No If NO, are you authorized to work in the U.S.? Yes No Are you at least 25 years of age? Yes No (This is a requirement of both insurance regulations & customer contracts)Have you ever been convicted of a felony or Misdemeanor? Yes No If YES, explain: Please check ALL of the applicable boxes below to indicate your preferred work shift and your personal schedule availability: Untitled “First” Shift (approx. 5:30 AM – 12:00 PM) “Second” Shift (approx. 12:00 PM – 7:00PM) Untitled Part Time Full Time FOR OFFICE ONLYInterview Date/Time MM slash DD slash YYYY Start Date/Time MM slash DD slash YYYY Starting Pay rateComments TRANSPORT ASSISTANCE INC. – DRIVER QUALIFICATIONSListed below are the minimum qualifications required of all Transport Assistance, Inc. driving personnel. Please note that these qualifications are conditions of employment and necessary to maintain compliance with Federal, State, and Local regulations and/or to meet contractual obligations with our customers. Please review each item carefully and place your initials in the indicated space to acknowledge your understanding of each. If you have any questions, please ask a member of Transport Assistance staff for clarification. * Please note that Office Staff and some Support Personnel may be exempt from any or all of these qualifications based on their duties* Each Driver must meet the following qualifications: 1. Be at least 25 years of age 2. Have a High School Diploma 3. Have a current & valid Ohio Driver’s License 4. Have fewer than four (4) points on their Ohio Driver’s License and supply a BMV Abstract Report to prove as such 5. No disqualifying felony convictions on their resulting BCI&I and/or FBI background report 6. Must not appear on the State of Ohio Abuser Registry 7. Be able to pass pre-hire DOT physical, breath alcohol, and urine sample drug testing 8. Must have NO history of seizures, seizure-like activity, or spells of fainting or blacking out 9. Have the ability to successfully pass recurring CPR & First Aid certification training programs 10. Must be able to endure extended periods of time behind the wheel of a motor vehicle (within Federal HOS guidelines) 11. Have NO physical limitations preventing them from moving about a van to ensure the safety of their passengers 12. Have the physical ability to assist passengers who ride in either manual or motorized wheelchairs 13. Is willing to have the Transport Assistance, Inc. release their driving, background, and training records to their customers, government regulators, and/or insurance carrier(s) as requested for compliance verification. **Please also note that a comprehensive Job Description will be reviewed with each new hire during Employee Orientation** EDUCATIONHigh School: From Date: MM slash DD slash YYYY To Date: MM slash DD slash YYYY GRADUATED? Yes No City & State: If no diploma, GED achieved? Yes No EMPLOYMENT HISTORY Please detail your most recent employers and any other employment experience that would be relevant to a Transportation Driver below. Most Recent Employer:Company Name: Phone:Address: Supervisor: Job Title: Ending Salary: $ Duties: Dates Employed From: MM slash DD slash YYYY To: MM slash DD slash YYYY Reason for Leaving: May we contact this employer for a reference? Yes No Relevant Employment Experience:Company Name: PhoneAddress: Supervisor: Job Title: Ending Salary: $ Duties: Dates Employed From: MM slash DD slash YYYY to MM slash DD slash YYYY May we contact this employer for a reference? Yes No Company Name: PhoneAddress: Supervisor: Job Title: Ending Salary: $ Duties: Dates Employed From: MM slash DD slash YYYY To: MM slash DD slash YYYY Reason for Leaving: May we contact this employer for a reference? Yes No ADDITIONAL QUALIFICATIONS Please list below any additional experiences, training, and/or skills that would make you an asset to Transport Assistance, Inc.:Why should Transport Assistance, Inc. hire you? ATTESTATION I attest that the information I have provided in this Job Application for employment with Transport Assistance, Inc. is complete and accurate to the best of my knowledge. I also understand that, if this Application should lead to employment, falsification of the information contained herein is an intolerable violation of Company policy and is grounds for immediate termination. Applicants Signature:Today’s Date: MM slash DD slash YYYY Files Drop files here or Select files Max. file size: 100 MB. *Please make your Driver’s License available so that Transport Assistance staff may make a copy to attach to this application
