Application – Employment – Health Link Logistic Group

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Employment Application

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Location

Phone

Best Time of Day to Contact You (check all that apply)

Early Morning, 7 a.m. - 9 a.m.

Morning, 9 a.m. - 12 Noon

Afternoon, 12 Noon - 5 p.m.

Evening, 5 p.m. - 8 p.m.

Do you have a car?

Yes

** We have our own van services as needed. Conditions apply**

Caregiver Information (check all that apply)

I am currently working at another agency

I have a patient - I have a patient and plan to bring them with me

I am a past employee – I have previously worked as a paid or unpaid caregiver

Logistics / Driver / Dispatcher Information (check all that apply)

I am currently working at another agency

I currently have CDL

I currently have passenger endorsements

I am a past employee

I have previously worked as van driver and/or transportstion provider

I have past experience dealing with clients with Mental Health / Disabilities

I have experience as a dispatcher

Expain Other