Driver Assistant Employment Application
Legacy 1115 Transportation LLC
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Thank you for your interest in joining Legacy 1115 Transportation. Please complete all applicable sections of this application accurately.
Applicant Information
First Name
Last Name
Email Address
Phone Number
Street Address
City
State
ZIP Code
Position & Availability
Position Applying For
Employment Availability
Select availability
Full-Time
Part-Time
Either
Date Available to Start
Days / Hours Available
Driver Assistant Qualifications
Do you have experience assisting passengers with mobility needs?
Select
Yes
No
Describe any experience with wheelchair, stretcher, patient transport, caregiving, healthcare support, or passenger assistance.
Are you comfortable assisting with wheelchair and stretcher transportation as trained?
Select
Yes
No
Are you able to follow safety procedures, dispatch instructions, and role-specific training requirements?
Select
Yes
No
Are you able to assist with safe loading, unloading, securement checks, and passenger support within your training?
Select
Yes
No
Additional relevant experience or qualifications
Employment History
Most Recent Employer
Position / Job Title
Employment Start Date
Employment End Date
Reason for Leaving
Professional References
Pre-Employment Requirements
Are you willing to complete required background screening?
Select
Yes
No
Are you willing to complete required drug screening?
Select
Yes
No
Do you currently hold CPR / First Aid certification?
Select
Yes
No
Certification in progress
Are you able to perform the passenger-assistance duties of this position with or without reasonable accommodation?
Select
Yes
No
Additional qualifications, certifications, or information
Applicant Certification
I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that providing false or misleading information may affect my eligibility for employment.
Applicant Full Name
Date
SUBMIT DRIVER ASSISTANT APPLICATION
