Jax Patient Care is accepting applications for Patient Care Transportation. 

To ensure proper consideration, please fill in the information below as completely and accurately as possible.
 
Office Address is 100A Wharfside Way, Jacksonville, FL 32207

Personal Information

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Certifications and Training *
 
Are you legally authorized to work in the United States? *

Availability

Jax Patient Care operates 7 days, 24 hours, light on weekends, must be available Monday thru Saturday. Indicate any all days available. *
Shift preference: Start times vary by day and can be as early as 4:00AM up until Noon. Schedules vary based upon trip schedules. Some long trips occasionally. We are beginning to add hospital discharges that could be throughout the night hours, 95% of our work is during the day. *
Employment Desired *
Scheduling Flexibility is a Requirement. Start times can range from 4:30AM to Noon, but end times can run from 1pm to 10pm. Rate your ability to be completely flexible for either of those shifts. *
 
Some patients can range in to the heavier side, how would you rate your self as moving via wheelchair a heavier (250lb. or more) patient safely up a low incline ramp or transferring from bed to stretcher? Also may involve tight quarters to properly attach restraints. *
 
Some Saturdays and Sundays are required per month. Rate your availability *
Occasional Sundays and Holidays are required *
 
Do you have your own personal reliable transportation to get to office at designated time? *
 

Employment History

Employer 1
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May we contact? *
 
 
 
Employer 2
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May we contact? *
 
 
 
Employer 3
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May we contact?
 
 
 
Employer 4
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May we contact?

References

Reference 1
 
 
Reference 2
 
 
Reference 3

Additional Skills


Disclosure and Background Check

DISCLOSURE AND AUTHORIZATION FOR BACKGROUND CHECK

I acknowledge receipt of this separate document entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION and certify that I have read and understand these documents. I hereby authorize the obtaining of "consumer reports" and/or "investigative consumer reports" by Jax Patient Care at any time after receipt of this authorization and throughout  my  employment,  if  applicable.   To this end, I  hereby  authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), Information service bureau, employer, or insurance company to furnish any and all background information requested by Occuscreen, UC, 805 Broadway Street, Suite 215, Vancouver, WA 98660, www.occuscreen.com, and/or Employer itself. I agree that a facsimile ("fax”), electronic or photographic copy of this Authorization shall be as valid as the original.

In order to process your background Check, please provide the following Information. Include your extra legal name and any other name(s) you may have used In the last seven (7) years.

*This information will be used for background screening purposes. *
 Please Complete
First Name
Middle Initial
Last Name
Birth Date
Social Security Number
Current Address
City
State
Zip Code
Driver License Number
State of Driver License
Other Names Used
Other City/States You Have Lived Last 7 Years

DISCLOSURE AND AUTHORIZATION

[IMPORTANT -   PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION]

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

 

Jax Patient Care (''the Company") may obtain Information about you from a third party consumer reporting agency for employment purposes. Thus, you may be the subject of a “Customer report" and/or an "Investigative consumer report" which may Include Information about your character, general reputation, personal characteristics, and/or mode of living, and which can Involve personal interviews with sources such as your  neighbors, friends, or associates. These reports may contain information regarding your credit history criminal history, social security verification, motor vehicle records (driving records"), verification of your education or employment history, or other background checks. Cred\t history will only be requested where such information ls     substantially related to the duties and responsibilities of the position for which you are applying.

You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any Investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of Investigative consumer report Is an employment history or verification. These searches will be conducted by Occuscreen, LLC, 805 Broadway Street, Suite 215, Vancouver, WA 98660, (888) 831-5804, www.occuscreen.com. The scope of this disclosure Is all-encompassing. however, allowing the Company to obtain from any outside organization all manner of consumer reports throughout the course of your employment to the extent permitted by law.

I agree that a facsimile (“fax"), electronic or photographic copy of this Authorization shall be as

 valid as the original.

JAX PATIENT CARE APPLICATION RELEASE AND WAIVER OF RIGHTS                                                                                                                                                                                                  

In exchange for the consideration of my job application by Jax Patient Care, I agree that                                                                                                    

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either In the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Jax Patient Care, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written Instrument signed by directors and management of Jax Patient Care. Both the undersigned may end the employment relationship at any time, without specified notice or reason. If employed, Iunderstand that Jax Patient Care may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction In benefits.

I authorize Investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for ls cause for dismissal at any time without any previous notice. I hereby give Jax Patient Care permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release Jax Patient Care from any liability as a result of such contract.

I also understand that (1) Jax Patient Care has a drug and alcohol policy that provides for reemployment testing as well as testing after employment; (2) consent to and compliance with such policy Is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that, In connection with the routine processing of your employment application, Jax Patient Care will request an investigative consumer report including Information as to my character, general reputation, personal characteristics, and mode of living. Upon written request from me, Jax Patient Care will provide me with additional Information concerning the nature and scope of any such report requested by It, as required by the fair credit reporting act.

I further understand that my employment with Jax Patient Care shall be probationary for a period of ninety (90} days, and further that at any time during the probationary period or thereafter, my employment relationship with Jax Patient Care Is terminable at will for any reason or no reason by either party.

Signature *
clear

JAX PATIENT CARE IS AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER. WE ADHERE TO A POLICY OF MAKING EMPLOYMENT DECISIONS WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, NATIONAL ORIGIN, CITIZENSHIP, AGE OR DISABILITY. WE ASSURE YOU THAT YOUR OPPORTUNITY FOR EMPLOYMENT WITH JAX PATIENT CARE DEPENDS SOLELY ON YOUR QUALIFICATIONS.