Join the WheelCare Team

First Name*
Middle/Maiden Name*
Last Name*
Email
Email*
Phone Numbers
Telephone*
Cell
Present Address
Street/Apt No.*
State
Zipcode*
Please enter a value between 10000 and 99999.
How Long at this address
Employment
Position Applied For*
Are you Currently Employed?*
- Yes
- No
If so, may we contact your employer?*
- Yes
- No
Name of Supervisor
Days/hours available to work
- No Preference
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Saturday
How many days/hours can you work weekly?
Can you work nights?
- Yes
- No
Employment Desired
- Part-time only Available at this time
Please Note: Though work hours can get long and often result in over-time, we are a part-time employer.
When would you be available to start work?
Number of years of schooling you have completed:
I attest, under penalty of perjury, that I am (check one of the following):
- A citizen of the United States
- A noncitizen national of the United States (See instructions)
- A lawful permanent resident
- An alien authorized to work until (expiration date. if applicable, mm/dd/yyyy) -------. Some aliens may write "NIA" in this field.
Alien Registration Number/USCIS Number
Expiration Date (If Applicable). Some alients may place "NIA" in this field.
Driver Job Duties Attestation
By submitting this form, I attest that I have the physical and mental ability to perform the job duties in the transportation of persons. I further attest that I am able to communicate in English. Printed Driver's Name Signature Organization's Name Date Signed

Email