Madison Taxi

Position

Position Applying for: * required

Yourself

Name: * required
Address:* required
City: * required
State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * required
Zip: * required
SS #: * required
E-mail: * required
Phone: * required
Phone 2:
Date of Birth:
* required

Emergency Contact

Name: * required
Phone Number: * required

Please explain why you want to drive a taxi? * required

Tell us about yourself (hobbies, etc.)

Physical History

Can you perform the necessary functions for the job? * required
Yes No

Are you capable of lifting 50 to 70 pounds? * required
Yes No
If No, why?

Have you ever been injured on the job? * required
Yes No

If yes, please describe injuries


How long ago did the injury occur?

Would you be willing to take a physical exam? * required
Yes No

Employment History

(Most recent Job First)

Military Status

Have you served in the U.S. Armed Forces? * required
Yes No

What Branch?

Discharge Date:

Are you presently in the Reserves?
Yes No

References

Please list 2 references other than employer and/or relatives.

Are you employed now? * required
Yes No

Rate of pay expected?

How did you learn about Madison Taxi?

Did one of our drivers refer you?
Yes No

If yes, what driver?

Education

What is the highest grade completed? (Please select)

Grade School 1 2 3 4 5 6 7 8 * required

High School 1 2 3 4

College 1 2 3 4 5 6 7 8+

Name of the last school you graduated from and/or attended:
* required

Driving History

Driving Data

Please select the types of vehicles you have driven and enter the approx. miles of experience in that type of vehicle:

Taxi Miles

Van Miles

Straight Truck Miles

Bus Miles

Semi Miles

Please select the states you have operated in:
(hold ctrl key to select more than one state)
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming - - - - - Military - - - - - Over Seas - - - - -

Office or Dispatch

For Office or Dispatch Positions: Experience in the following areas:
Typing

Billing

Data Entry
Calculator
Cashier
Dispatch
Accounting
Mechanic
Other

Applicant's E Signature: * required

Signing Date: * required

I certify: * required
I certify that l completed this application, and that all entries on it and information on it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, financial, medical history, etc., as may be necessary in arriving at an employment decision. I understand that false or misrepresented information given in the application process may result in either non-consideration for employment or discharge. I hereby release employers, schools, or persons from all liability in responding to inquiries in connection with my application.

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