Modus Employment Application Welcome to the Modus Employment Application. Thank you for your desire to serve as part of the Modus team. Please complete the information requested below to submit your application for review. * indicates a required field Position * Client Transportation Specialist (Part-Time) Transportation Coordinator (Full-Time) Please indicate which shift(s) you are available to work. Required for Client Transportation Coordinator. Select all that apply. Morning Shift (8:30-12:30) Afternoon Shift (12:30-4:30) Evening Shift (4:30-8:30) Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Highest Level of Education Completed * High School Diploma/GED Associate Degree Bachelor Degree Master Degree or Doctrate None of the Above Language * Select all that apply. English Spanish Other How did you hear about us? * Select all that appy. Facebook Linkedin Instagram Twitter Google Other Internet Search Engine Referral/Word-of-Mouth Networking/Community Event Job Fair Other If you were referred to Modus, who can we thank? First & Last Name Are you 21 years old or older? * Yes No Are you legally authorized to work in the United States? * Yes No Will you now or in the future require visa sponsorship? * Yes No Do you have a valid driver's license & vehicle insurance? * Yes No Do you have a reliable vehicle? * Yes No Have you ever been convicted of any crime (excluding minor traffic violations) including DWI/DUI? * Yes No Desired Start Date * MM DD YYYY Desired Salary * ex. $X/hour or $X/year Briefly explain why you chose to apply for this position. Summarize your experience working with underserved populations. * Reference #1 Name * First Name Last Name Reference #1 Phone * (###) ### #### Reference #2 Name * First Name Last Name Reference #2 Phone * (###) ### #### Reference #3 Name * First Name Last Name Reference #3 Phone * (###) ### #### Authorization and Certification * I certify that my answers to the foregoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge. I understand that Modus will conduct a background check (including a criminal background check and motor vehicle report) as a condition of employment. I agree that, if I am employed, I will abide by all the rules and regulations of Modus. I further understand that nobody in Modus is authorized to enter into any written or verbal employment contracts with me for any definite period of time without express written consent. I also understand that my employment is “at-will” and may be terminated by me or by Modus at any time for any reason or for no reason at all, with or without prior notice. I understand that typing my name here represents my signature and prior to myself being hired a legal signature will be required. Today's Date * MM DD YYYY Your application was successfully submitted. If you meet the requirements of the position, we will be in touch soon.
