EMPLOYMENT APPLICATION

Transcription

1 EMPLOYMENT APPLICATION INSTRUCTIONS: Thank you for your interest in employment with Lebanon Transit. Please complete all sections of this employment application to be considered for employment. If you require accommodation during the employment application process, including assistance in the completion of the employment application, please let us know. We are an Equal Opportunity Employer. We do not discriminate on the basis of age, race, sex, religion, color, national origin, ancestry, marital status, disability, sexual orientation, arrest and court record or any other protected category recognized by Pennsylvania and federal laws. This employment application is valid for a three-month period after submission, and only for the desired position. Consideration for employment after the three-month period requires completion and submission of a new application. Use additional paper if necessary to provide complete answers to any questions. Section I: Personal Information Name: Date: Home Address: City/State/Zip: Phone: Are you at least 21 years of age? Yes No (DO NOT PROVIDE DATE OF BIRTH) Section II: Referral Source (Please check the appropriate category and name the source) Advertisement/Newspaper Company Website Employee Referral Job Fair Craig s List Staffing Agency Walk-In Other Section III: Desired Position Desired Position: Available start date: Compensation desired: Have you ever applied for Where: When: Employment at Lebanon Transit before? Have you ever worked for Where: When: Lebanon Transit before? Please list any other name under which you have been employed: Are you legally authorized to work in the United States on an unrestricted basis for any employer? Have you ever been convicted of a felony or a misdemeanor? Yes No If yes, please explain: Applicants are not obligated to disclose sealed or expunged arrest or conviction records.

2 Section IV: Education Education/Type Name & City Did you graduate? Degree Received High School College Graduate School Other Section V: Employment History Name of Present or Last Employer: May we contact your employer? Yes No if no, why not?

3 Section V: Employment History Continued Employment Gaps: Explain any periods that you were not working during the last 10 years other than due to personal illness, injury or disability. Related Information: If you are a member of any job related organizations (professional, trade, etc.) or have received any job related awards or accomplishments, list and describe them. Exclude any information that would reveal your age, race, sex, religion, color, national origin, ancestry, marital status, disability, sexual orientation, arrest and court record or any protected category.

4 Job Skills and Qualifications: Summarize any special training skills, licenses and/or certificates that may assist you in performing the position for which you are applying. Are you bilingual? If so, what language? Have you served in the military? If so, type of discharge? Honorable General Other Section VI: Driver s License Information: Driver s License State Class License No. Endorsements Restrictions Expiration Date Driving Experience: Dates Class of Equipment Type of Equipment From - To Approx. No. of Miles (Van, Tank, Flat, etc.) (Total) Bus Tractor and Semi- Trailer Tractor Two Trailers Accident Record for the Past 3 years (attach sheet if more space is needed) Last Accident Date Nature of Accident Fatalities Injuries (Head-On, Rear-End, Upset, etc,) Next Previous Next Previous Traffic Convictions and Forfeitures for the Past 3 Years (Other than parking violations) LOCATION DATE CHARGE TYPE OF VEHICLE OPERATED

5 Section VII: Acknowledgement Certification Authorization Certification PLEASE READ CAREFULLY BEFORE SIGNING 1. I certify that the information contained in this application for employment at Lebanon Transit is correct and complete. I understand that any false or misleading statements or omissions made in this application or interview(s), whenever discovered, are grounds for disqualification from further consideration or for dismissal from employment, regardless of how discovered. 2. I understand that if I am offered employment at Lebanon Transit, it is at-will and can be terminated at any time and for any reason with or without advance notice by myself or Lebanon Transit. 3. I understand and agree that Lebanon Transit may make a full and complete investigation of my personal employment history, and authorize any former employer, person, firm, corporation, school, government agency, or other entity to provide Lebanon Transit with any information (including fact or opinion) they may have regarding me. In consideration of Lebanon Transit s review of this application, I release Lebanon Transit and all providers of information from any liability which may arise as a result of furnishing or receiving this information. I understand and agree that any employment offer or continued employment shall authorize Lebanon Transit to provide truthful information (fact or opinion) regarding my employment to any potential or future employer and release and waive any claims against Lebanon Transit for truthfully communication any such information to a potential or future employer. 4. I understand and agree that I will be required to submit to drug and alcohol testing and may be required to complete post-offer medical examination as part of my application for employment. I also understand and agree that I may be required to submit to a complete medical examination during my employment with Lebanon Transit, provided that such examination is job-related and consistent with business necessity. I authorize the physician or collection site to disclose the results of the examination and the laboratory test to Lebanon Transit in accordance with state and/or federal laws. Lebanon Transit will keep such results confidential and disclose the results only to persons who need to know where required by law. Also, I agree to fully cooperate and provide Lebanon Transit with any additional consent(s) and/or release(s) as required by Lebanon Transit to investigate my employment application. 5. I understand that Lebanon Transit will obtain information and consider any criminal conviction record that I may have either before or after it makes a conditional offer of employment. Lebanon Transit may withdraw a conditional employment offer based on the results of a criminal conviction record. 6. I understand and agree that if offered employment by Lebanon Transit I may be required to disclose military service information in accordance with law, and that any such employment offer shall depend upon the receipt of satisfactory military record as determined by Lebanon Transit. Authorization/Signature of Applicant: Date