“; echo “Please go back and correct these errors:
“; echo “
- “;
echo $error;
echo “
Thank you for your inquiry
“; echo ““; echo “We will be in touch with you very soon.
“; echo “
“; $email_message .= ‘
AFFILIATED CARRIAGE SYSTEMS INC
DBA Madison Taxi
Employment Application
In compliance with federal and state equal employment opportunity laws, qualified applicants are considered for all positions, without regard to race, color, religion, sex, national origin, age, marital status, or the presence of a non-job related medical condition or handicap.
Affiliated Carriage Systems Inc., is in compliance with U.S. Department of Transportation, Urban Mass Transportation Administration regulation 49 CFR Part 653 (“Control of Drug Use in Mass Transportation Operations”). Under Subpart B (“Drug Testing”) of this regulation, Article 653 (“Pre-employment testing”) reads, in part:
"An individual may not be hired to perform a sensitive safety function unless the individual passes a drug test administered under this section …. A preemployment drug test required by this section may be administered only after the person to be tested is informed that the urine sample being collected will be tested for evidence of (1) marijuana; (2) cocaine; (3) opiates; (4) phencyclidine (PCP), and (5) amphetamines"
‘.$PositionApplying.’ Date: ‘.$sigdate.’
‘.$Name.’
‘.$Address.’
‘.$City.’
‘.$State.’
‘.$Zip.’
‘.$mt_ss.’
‘.$mt_email.’
‘.$phone.’
‘.$cell.’
‘.$dob.’
Emergency Contact
‘.$EmergencyContactName.’
‘.$EmergencyContactPhone.’
‘.$why_drive_taxi .’
‘.$hobbies.’
Physical History
Can you perform the necessary functions for the job? ‘.$functions.’
Are you capable of lifting 50 to 70 pounds? ‘.$capable.’
‘.$capabln.’
Have you ever been injured on the job? ‘.$injured.’
‘.$injureyes.’
‘.$injurepdate.’
Would you be willing to take a physical exam? ‘.$physical.’
Employment History
(Most recent Job First)
‘.$EmploymentName1.’
‘.$EmploymentPosition1.’
‘.$EmploymentDescription1.’
‘.$EmploymentReason1.’
Would this Employer rehire you? ‘.$rehire1.’
‘.$rehireawhy1.’
‘.$From1.’ ‘.$To1.’
– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – — – – – – – – – – – –
‘.$EmploymentName2.’
‘.$EmploymentPosition2.’
‘.$EmploymentDescription2.’
‘.$EmploymentReason2 .’
Would this Employer rehire you? ‘.$rehire2.’
‘.$rehireawhy2.’
‘.$From2.’ ‘.$To2.’
– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – — – – – – – – – – – –
‘.$EmploymentName3.’
‘.$EmploymentPosition3.’
‘.$EmploymentDescription3.’
‘.$EmploymentReason3.’
Would this Employer rehire you? ‘.$rehire3.’
‘.$rehireawhy3.’
‘.$From3.’ ‘.$To3.’
Military Status
Served in the U.S. Armed Forces: ‘.$served.’
‘.$Branch.’
‘.$DDischarge.’
Presently in the Reserves? ‘.$reserves.’
References
Please list 2 references other than employer and/or relatives.
Reference 1
‘.$referencesname1.’
‘.$referencesAddress1.’
‘.$referencesTelephone1.’
‘.$referencesEmail1.’
May we call or email this reference? ‘.$callreferences1.’
Reference 1
‘.$referencesname2.’
‘.$referencesAddress2.’
‘.$referencesTelephone2.’
‘.$referencesEmail2.’
May we call or email this reference? ‘.$callreferences2.’
– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – — – – – – – – – – – –
‘.$employed.’
– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – — – – – – – – – – – –
‘.$prate.’
– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – — – – – – – – – – – –
‘.$learnabout.’
‘.$driver.’
‘.$driverrefername.’
Education
What is the highest grade completed?
‘.$GradeSchool.’
‘.$HighSchool.’
‘.$College.’
Name of the last school you graduated from and/or attended: ‘.$lastschool.’
Driving History
‘.$DLNUM.’
‘.$DLEXP.’
– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – — – – – – – – – – – –
Have a CDL: ‘.$CDLYN.’
‘.$CDLEXP.’
-
Denied a license permit or privilege to operate a motor vehicle: ‘.$denied.’
‘.$deniedex.’
‘.$revoked.’
‘.$revokedWW.’
-
‘.$crime.’
‘.$crimeex.’
-
‘.$drug.’
‘.$drugW.’
Driving Data
Please select the types of vehicles you have driven and enter the approx. miles of experience in that type of vehicle:
‘.$taxi_miles.’
‘.$Van_miles.’
‘.$truck_miles.’
‘.$Bus_miles.’
‘.$Semi_miles.’
‘.$experiemcestates.’
Office or Dispatch
For Office or Dispatch Positions please select your experience in the following areas.
‘.$Positio1Typing.’
‘.$Positio2Billing.’
‘.$Positio3DataEntry.’
‘.$Positio4Calculator.’
‘.$Positio5Cashier.’
‘.$Positio6Dispatch.’
‘.$Positio7Accounting.’
‘.$Positio8Mechanic.’
‘.$Positio9Other.’
‘.$signame .’
‘.$sigdate.’
‘.$certify.’
‘; $email_message .= ‘Office Use:
Form 6102-MT-EMP: □ □ □ □ □
‘.$_SERVER[‘REMOTE_ADDR’].’
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