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Menu
Home
About
About Us
70th Anniversary
Who We Serve
News Room
Voices@Vivalon Blog
Our Team
Executive Leadership
Board of Directors
Fundraising and Marketing
Mission and Values
Our History
Awards
Community Partners
About our Name
Financials
Rent Our Facility
Rides
Rides
Assisted Rides & CarePool Free Volunteer Rides
Medical Rides
Business Services
Title VI Civil Rights Policy
Meals
Meals & Nutrition
Meals on Wheels
Nourish Home-Delivered Meals
Vivalon Café
Brown Bag Pantry
Monthly Food Box
Programs
Class Schedule
Healthy Aging Campus
Healthy Aging Programs
Arts & Community Activities
Health & Wellness Classes
Technology for Better Living
Educational & Experiential Offerings
Cowles Active Learning Program
Resources
Become a Member
Rent Our Facility
Employment
Jobs at Vivalon
Volunteer
Volunteer at Vivalon
Volunteer Application
Ways to Support
Donate
Ways to Support
Donate Monthly
Donate Your Vehicle
Planned Giving
Donor Advised Funds
Charitable IRA
Stocks and Mutual Funds
Leadership Circle
Special Events
Employee Giving
Sponsorships
Wish List
Financials
Driver Employment Application
Step
1
of
4
25%
Vivalon Driver Application for Employment
930 Tamalpais Ave, San Rafael, CA 94901. Phone: 415-456-9062 | Fax: 415-456-1581 | vivalon.org. Vivalon is an Equal Opportunity Employer
Name
First
Middle
Last
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
Home Phone
Cell Phone
Employment Desired
Position Applying For
Driver
Pay Desired
Are you applying for regular full-time work?
Yes
No
Are you applying for regular part-time work?
Yes
No
What days and hours are you available to work?
If hired, on what date can you start work?
How did you hear about this employment opportunity?
Personal Information
Have you ever applied to or worked for Vivalon (or Whistlestop) before?
Yes
No
If yes, when?
Do you have any friends or relatives working for Vivalon?
Yes
No
Name of Friend or Relative
Relationship
In the last 3 years have you failed or refused a DOT (Dept. of Transportation) pre-employment drug or alcohol test administered by an employer regardless of whether or not you obtained work with said employer?
Yes
No
In the last 3 years, were you subject to Department of Transportation (DOT) regulated drug or alcohol testing on any job? If yes, please include this job information in the Employment History section on page 3.
Yes
No
If hired, would you have a reliable means of transportation to and from work?
Yes
No
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this county?
Yes
No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
Yes
No
If no, please describe the functions that cannot be performed:
Answer the following questions if you are applying for a professional position
Are you licensed/certified for the job applied for?
Yes
No
License/certification number
Expiration Date
Issuing State
License Class
Has your license/certification ever been revoked or suspended?
Yes
No
If yes, state the reason(s), date of revocation or suspension, and date of reinstatement:
Employment History
List below all present and past employment starting with your most recent employer (last 10 years is sufficient). Please complete this section even if attaching a resume.
Name of Employer
Phone Number
Type of Business
Supervisor's Name
Your Position
Duties
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Start Date
End Date
Reason for Leaving
May we contact this employer for a reference?
Yes
No
Were you subject to DOT drug or alcohol testing at this job?
Yes
No
Second Employment
Click "yes" to enter a second employment history.
Yes
No
Name of Employer
Phone Number
Type of Business
Supervisor's Name
Your Position
Duties
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Start Date
End Date
Reason for Leaving
May we contact this employer for a reference?
Yes
No
Were you subject to DOT drug or alcohol testing at this job?
Yes
No
Third Employment
Click "yes" to enter a third employment history.
Yes
No
Name of Employer
Phone Number
Type of Business
Supervisor's Name
Your Position
Duties
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Start Date
End Date
Reason for Leaving
May we contact this employer for a reference?
Yes
No
Were you subject to DOT drug or alcohol testing at this job?
Yes
No
Fourth Employment
Click "yes" to enter a fourth employment history.
Yes
No
Name of Employer
Phone Number
Type of Business
Supervisor's Name
Your Position
Duties
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Start Date
End Date
Reason for Leaving
May we contact this employer for a reference?
Yes
No
Were you subject to DOT drug or alcohol testing at this job?
Yes
No
Professional References
Please list three professional work references who have knowledge of your recent work performance.
Name
Phone
Email
Occupation
Work Relationship
Years Acquainted
Second Reference
Click "yes" to enter a second reference.
Yes
No
Name
Phone
Email
Occupation
Work Relationship
Years Acquainted
Third Reference
Click "yes" to enter a third reference.
Yes
No
Name
Phone
Email
Occupation
Work Relationship
Years Acquainted
Please read carefully and sign below
(Required)
I have read and understand the below requirements.
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I hereby authorize Vivalon to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the agency any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the agency, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
I understand that nothing contained in the, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the agency. In addition, I understand and agree that if I am employed, my employment is (At-will) for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the agency, and that no promises or representations contrary to the foregoing are binding on the agency unless made in writing and signed by me and the agency’s designated representative.
Upon employment, you will be required to submit to a finger print criminal record background check and may be required again in three years. Conviction of certain sexual felonies will disqualify you for continued employment with Vivalon.
If I am applying for a job that involve driving my own vehicle or a company vehicle on behalf of Vivalon, I herby authorize Vivalon’s insurance company and/ or Heffernan Insurance Brokers to be in possession of my drivers license number, obtain the necessary motor vehicle records and authorize them to send a copy of my Motor Vehicle Record to Vivalon.
Signature
(Required)
Please sign with your mouse. By signing you consent to all of the above.
Date
MM slash DD slash YYYY
Upload Resume
Max. file size: 256 MB.
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Step
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25%
Vivalon Driver Application for Employment
930 Tamalpais Ave, San Rafael, CA 94901. Phone: 415-456-9062 | Fax: 415-456-1581 | vivalon.org. Vivalon is an Equal Opportunity Employer
Name
First
Middle
Last
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
Home Phone
Cell Phone
Employment Desired
Position Applying For
Driver
Pay Desired
Are you applying for regular full-time work?
Yes
No
Are you applying for regular part-time work?
Yes
No
What days and hours are you available to work?
If hired, on what date can you start work?
How did you hear about this employment opportunity?
Personal Information
Have you ever applied to or worked for Vivalon (or Whistlestop) before?
Yes
No
If yes, when?
Do you have any friends or relatives working for Vivalon?
Yes
No
Name of Friend or Relative
Relationship
In the last 3 years have you failed or refused a DOT (Dept. of Transportation) pre-employment drug or alcohol test administered by an employer regardless of whether or not you obtained work with said employer?
Yes
No
In the last 3 years, were you subject to Department of Transportation (DOT) regulated drug or alcohol testing on any job? If yes, please include this job information in the Employment History section on page 3.
Yes
No
If hired, would you have a reliable means of transportation to and from work?
Yes
No
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this county?
Yes
No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
Yes
No
If no, please describe the functions that cannot be performed:
Answer the following questions if you are applying for a professional position
Are you licensed/certified for the job applied for?
Yes
No
License/certification number
Expiration Date
Issuing State
License Class
Has your license/certification ever been revoked or suspended?
Yes
No
If yes, state the reason(s), date of revocation or suspension, and date of reinstatement:
Employment History
List below all present and past employment starting with your most recent employer (last 10 years is sufficient). Please complete this section even if attaching a resume.
Name of Employer
Phone Number
Type of Business
Supervisor's Name
Your Position
Duties
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Start Date
End Date
Reason for Leaving
May we contact this employer for a reference?
Yes
No
Were you subject to DOT drug or alcohol testing at this job?
Yes
No
Second Employment
Click "yes" to enter a second employment history.
Yes
No
Name of Employer
Phone Number
Type of Business
Supervisor's Name
Your Position
Duties
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Start Date
End Date
Reason for Leaving
May we contact this employer for a reference?
Yes
No
Were you subject to DOT drug or alcohol testing at this job?
Yes
No
Third Employment
Click "yes" to enter a third employment history.
Yes
No
Name of Employer
Phone Number
Type of Business
Supervisor's Name
Your Position
Duties
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Start Date
End Date
Reason for Leaving
May we contact this employer for a reference?
Yes
No
Were you subject to DOT drug or alcohol testing at this job?
Yes
No
Fourth Employment
Click "yes" to enter a fourth employment history.
Yes
No
Name of Employer
Phone Number
Type of Business
Supervisor's Name
Your Position
Duties
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Start Date
End Date
Reason for Leaving
May we contact this employer for a reference?
Yes
No
Were you subject to DOT drug or alcohol testing at this job?
Yes
No
Professional References
Please list three professional work references who have knowledge of your recent work performance.
Name
Phone
Email
Occupation
Work Relationship
Years Acquainted
Second Reference
Click "yes" to enter a second reference.
Yes
No
Name
Phone
Email
Occupation
Work Relationship
Years Acquainted
Third Reference
Click "yes" to enter a third reference.
Yes
No
Name
Phone
Email
Occupation
Work Relationship
Years Acquainted
Please read carefully and sign below
(Required)
I have read and understand the below requirements.
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I hereby authorize Vivalon to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the agency any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the agency, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
I understand that nothing contained in the, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the agency. In addition, I understand and agree that if I am employed, my employment is (At-will) for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the agency, and that no promises or representations contrary to the foregoing are binding on the agency unless made in writing and signed by me and the agency’s designated representative.
Upon employment, you will be required to submit to a finger print criminal record background check and may be required again in three years. Conviction of certain sexual felonies will disqualify you for continued employment with Vivalon.
If I am applying for a job that involve driving my own vehicle or a company vehicle on behalf of Vivalon, I herby authorize Vivalon’s insurance company and/ or Heffernan Insurance Brokers to be in possession of my drivers license number, obtain the necessary motor vehicle records and authorize them to send a copy of my Motor Vehicle Record to Vivalon.
Signature
(Required)
Please sign with your mouse. By signing you consent to all of the above.
Date
MM slash DD slash YYYY
Upload Resume
Max. file size: 256 MB.
Δ
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