Phone: 575-523-2244 | Fax : 575-523-9977

Job Application

Fields marked with an asterisk (*) must be filled out before submitting.

 

Personal Details

First Name *
Last Name *
Street Address *
City *
State *
Zip Code *
Phone Number *
Date of Birth *
Driver License Number *
Driver License State *
Email Address *
If hired, can you provide proof that you are legally able to work? * Yes
No
How were you referred to us? *
Have you ever been convicted of a criminal offense (felony or misdemeanor)? * Yes
No
If yes, please state nature of offense(s), date(s), city, state, and disposition of the offense
List any friends or relatives employed by MedTrans

Employment

What days and hours are you available for work? *
What date are you available to begin work? *

Skills

What knowledge, special skills, and/or credentials do you have which especially prepare you for the position applied for?

Education

Name & City of School of latest school *
Years Completed *
Degree(s) or Diploma(s)

Employment History

Company Name *
Address *
Date Started *
Is this your current employer? *
If not, last date of work
May we contact this employer? * Yes
No
Specific job duties *
Reason for leaving *

Personal References

Name of 1st Reference *
Address *
Phone Number *
Name of 2nd Reference *
Address *
Phone Number *

In Case of Emergency

Name *
Address *
Phone Number *
Relationship *
The information that I have provided on this application is accurate to the best of my knowledge and may be verified by MedTrans or its agents * Yes
I understand that MedTrans is committed to maintaining a drug and alcohol free work place. Accordingly, I may be subject to a pre-employment blood test, urinalysis, or any other drug/alcohol screening. I further understand that if employed, I may be subject to random drug and alcohol screening at any given time, or if MedTrans has reasonable suspicion to believe that I am under the influence of any drug or alcohol. My consent to submit to such a test is required as a condition of employment and my refusal to consent shall result in a refusal to hire or, if already employed, result in termination. * Yes
I understand and agree that any misrepresentation or omission of facts in this application will be justification for refusal or termination of employment, regardless of the time elapsed before discovery * Yes
I understand and agree that the employment for which I am applying for is at-will and such employment may be terminated at any time with or without cause, without prior notice, by either myself or Medtrans. There will be no agreement, express or implied between MedTrans and me for any specific period of employment * Yes
I have completed the entire application to the best of my ability and have carefully read and understood the statements in which I have initialed * Yes
Privacy Policy * I have read and understood the privacy policy.
 

Office hours

  • Monday:8am-6pm
  • Tuesday:8am-6pm
  • Wednesday:8am-6pm
  • Thursday:8am-6pm
  • Friday:8am-6pm
  • Saturday:Closed
  • Sunday:Closed

Transportation Hours

  • Monday:24 Hours
  • Tuesday:24 Hours
  • Wednesday:24 Hours
  • Thursday:24 Hours
  • Friday:24 Hours
  • Saturday:24 Hours
  • Sunday:24 Hours

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