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Driver Applicant Information

Applicant Information

Full Name*

Phone Number*

Email Address*

Address*

Position Applying For

Wheelchair Van DriverStretcher Van DriverAmbulatory DriverOther

Available Start Date*

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Employment Type

Full-TimePart-TimePer Diem

Driver Qualifications

Do you have a valid Driver's License?

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Driver's License Number

State Issued

Expiration Date

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Do you have a clean driving record?

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Years of Driving Experience

0–11–33–55+

Certifications & Training

Check all that apply

CPR CertifiedFirst Aid CertifiedDefensive DrivingWheelchair Securement TrainingPassenger Assistance TrainingHIPAA Awareness

Are you willing to complete required training if not certified?

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Experience

Do you have experience in Non-Emergency Medical Transportation (NEMT)?

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Have you worked with

Nursing HomesHospitalsAssisted Living FacilitiesDialysis Centers

Briefly describe your driving or healthcare-related experience

Availability

Days Available

MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Hours Available

MorningAfternoonEvening

Background & Compliance

Are you willing to undergo a background check?

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Are you willing to take a drug screening test?

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Are you authorized to work in the U.S.?

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Additional Information

Upload Resume (optional)

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PDF or Word, up to 5MB.

I certify that the information provided is accurate and complete.*

Trusted, Fully Licensed & Insured Non-Emergency Medical Transportation (NEMT) Provider

Popular Medical Services delivers safe, reliable non-emergency medical transport for ambulatory, wheelchair, stretcher, and bariatric riders.

Company

Home
About Us

Services

Ambulatory Transport
Wheelchair Transport
Bariatric Transport
Stretcher Transport

Customer Services

610.257.7077
Info@popularmedicalservices.com
Center Valley, PA 18034