JobRide Application - YWCA Madison

The service is full at this time. Please complete this application to be added to our waitlist. Completion of this application does NOT guarantee transportation. If you currently reside within a bus line and have access during service hours, we cannot accept your application for transportation. Our routes are pre-scheduled. Work days/times must be entered in order for your application to be considered. All information you provide is for eligibility and reporting purposes only.

Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Employer(Required)

Gender(Required)

Date of Birth(Required)

Race/Ethnicity(Required)

Annual Household Income(Required)

Total number of people in the household(Required)

Number of children under the age of 18(Required)

Current employment situation(Required)

JobRide will help me(Required)

Please make between 1 & 2 selections from the choices below.

Get a job

Keep a job

Get a better job

Do you have a transportation alternative available?(Required)

If yes, what?

Employer Street Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is this a temp agency?(Required)

If your work location is different than your employer's address, enter drop-off location here.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Schedule:

Our routes are pre-scheduled. Work days/times must be entered in order for your application to be considered.

Is your work schedule fixed or variable?(Required)

If schedule is variable, please give us the details here.

If your work schedule is fixed, complete shift start and end times like this example : 4:30 am - 12:00 pm.

Sunday shift start time

Sunday shift end time

Monday shift start time

Monday shift end time

Tuesday shift start time

Tuesday shift end time

Wednesday shift start time

Wednesday shift end time

Thursday shift start time

Thursday shift end time

Friday shift start time

Saturday shift start time

Saturday shift end time

Demographics:

These responses are required for FoodShare Employment and Training program tracking. All information is kept strictly confidential.

Do you have a disability that requires alternate accommodations?(Required)

Do you use any of the following:

Please select from the available option or select other and enter information below.

If other, please explain here.

Are you eligible for ParaTransit?(Required)

How did you hear about JobRide(Required)

Please make between 1 and 9 selections from the choices.

From a current JobRide user

From a friend

From a brochure

From an advertisement

From an employer

From a search engine (for example Google)

From YWCA Madison's website

From another website

From another source

If referred by a current JobRide user, please provide their full name for a referral discount.

Comments, questions, or suggestions