PERSONAL DATA SECONDARY PHONE NO When:

Transcription

1 PRINT LEGIBLY IN INK (Last) FULL TIME BUS OPERATOR 180 Boyden Ave Maplewood NJ PERSONAL DATA ` DAY DATE SOCIAL SECURITY NUMBER - - (First) MI Date of Birth: - - (Number) (Street) DO T USE A PO BOX (Apartment Number Suite) CITY STATE ZIP CODE FULL PRIMARY PHONE SECONDARY PHONE If hired you will be required to furnish proof that you are legally authorized to work in the United States Are you legally able to work in the United States? Have you ever been employed by NJ Transit? Position Held: When: Do you have any relatives working for NJ Transit? If PLEASE COMPLETE THIS SECTION : JOB TITLE: RELATIONSHIP: LOCATION: RELATIVES WILL T BE EMPLOYED UNDER DIRECT SUPERVISION OF ONE ATHER R WILL THEY BE PLACED IN THE SAME DEPARTMENT IF IN NJ TRANSIT'S OPINION THIS COULD RESULT IN POTENTIAL CONFLICTS OF INTEREST EDUCATIONAL RECORD HAVE YOU COMPLETED Name Street City and State of School DiplomaDegree or Credits Earned Field of Study High School or GED College College Professional or Technical Schools Graduate NEW JERSEY TRANSIT IS AN EQUAL OPPORTUNITY EMPLOYER Draft PAGE 15

2 APPLICANT HISTORY PLEASE ACCOUNT FOR YOUR TIME DURING THE PAST TEN (10) S INCLUDING JOBS SCHOOLING UNEMPLOYMENT SELF- EMPLOYMENT MILITARY SERVICE ETC IF YOU NEED ADDITIONAL SPACE PLEASE ASK FOR ADDITIONAL PAGES Supervisor's Name Supervisor's Title Supervisor's Phone Supervisor's Name Supervisor's Title Supervisor's Phone Supervisor's Name Supervisor's Title Supervisor's Phone PAGE 2 5

3 APPLICANT HISTORY PLEASE ACCOUNT FOR YOUR TIME DURING THE PAST TEN (10) S INCLUDING JOBS SCHOOLING UNEMPLOYMENT SELF- EMPLOYMENT MILITARY SERVICE ETC IF YOU NEED ADDITIONAL SPACE PLEASE ASK FOR ADDITIONAL PAGES Supervisor's Name Supervisor's Title Supervisor's Phone Supervisor's Name Supervisor's Title Supervisor's Phone Duties You Must Describe Vehicles Driven (If applicable) Supervisor's Name Supervisor's Title Supervisor's Phone PAGE 35

4 DATE AVAILABLE MINIMUM SALARY ACCEPTABLE $ SKILLS What led & you to apply (Please to indicate NJ TRANSIT? each position (Circle that One) you are applying Ad for Agency by filling in the appropriate Job Fair circle next Walk-in to that position) EXPERIENCES Employee Internet Other PT - Bus Operator Ticket Vending Machine Maintainer Accounting Finance Please specify the Ad Agency Job Fair Walk-in Employee Internet Other: PT - Ticket Agent Laborer Nurse List 003 previous - PT - Transit residences Information for Clerk the last three 203 -(3) CAM years (Rail and Car give Cleaner) dates lived at each address Medical Technician Street Address Machinist City Bus Cleaner State Zip Dates Resided Public Relations Mechanic Car Inspector (Train) Paralegal Pipefitter Assistant Conductor Supervisor - Maintenance Bus Service Person Locomotive Engineer Supervisor - Operations Bus Mechanic Clerical Human Resources Electrician AdministrativeSecretarial Doctor Additional Disclosures All Bus Operator Applicants: The information you provide regarding your current or previous employers will be used and your current or previous employers will be contacted for the purpose of investigating your safety performance history information as required by FMCSA regulations As a prospective driver employee you have the following rights regarding the information provided to NJ TRANSIT by your current or previous employers: The right to review information provided by previous employers; The right to have errors in the information corrected by the previous employer and for that previous employer to resend the corrected information to NJ TRANSIT; The right to have a rebuttal statement attached to the alleged erroneous information if you and your previous employer cannot agree on the accuracy of the information PAGE 45

5 ALL SECTIONS MUST BE COMPLETED TO BE CONSIDERED FOR EMPLOYMENT DRIVER S LICENSE INFORMATION All Licenses or Permits Held Within the Past 3-Years Issuing State License Number TypeClass Endorsements Restrictions if Any Expiration Date Have Any of the Above Listed License(s) or Permits Been Suspended Denied Revoked? If Please Complete the Information Below: When? Reason From To Please list all motor vehicle accidents you have been involved in during the past three (3) years Date of accident Nature of accident Any fatalities or personal injury? Do you have any Motor Vehicle Offenses andor Convictions? If list all violations (except parking) for which you were convicted or forfeited bond or collateral in the past 3 years All applicants will be thoroughly investigated Therefore any omission or willful mis-statement will be cause for disqualification for employment DATE DATE OF VIOLATION OFFENSE DATE OF CONVICTION DISPOSITION AND FINE (Forfeited Bond Collateral Points etc) OF COURT AND LOCATION APPLICANT'S CERTIFICATION AGREEMENT & AUTHORIZATION This certifies that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge I understand that if I provide any misleading or incorrect information during the employment process it may render this application void and result in my immediate termination if the misleading or incorrect nature of the information is discovered if and after I am employed I hereby authorize my former employers to release any information they may have concerning my employment with them and hereby release NJ TRANSIT (hereinafter the Company ) and all previous employers listed above from all liability whatsoever that may ensue from providing or securing this information I further authorize representatives of the Company to take all reasonable actions to verify any and all information contained herein and to obtain and review any and all criminal history driving and disciplinary records of any sort that may exist concerning me If the Company employs me I agree to conform to the rules and regulations of the Company I understand that if I am employed in a position not covered by a labor agreement my employment will be at will and that my employment can be terminated at any time with or without cause and with or without advance notice by either the Company or myself Moreover as a non-agreement employee I understand that no manager or representative of the Company other than the Executive Director of NJ TRANSIT or the Executive Director s Designee has any authority to make an offer of employment andor to make any agreement with me contrary to or different than the terms contained in this affidavit and authorization I understand that if I am employed in a position covered by a labor agreement and successfully complete the probationary period prescribed by such agreement NJ TRANSIT may terminate my employment in accordance with the provisions of the applicable labor agreement It is the Company s policy to hire and promote without regard to race color creed sex age national origin religion veteran status handicap and sexual orientation or any other status protected by law I agree that I will support such a policy if the Company employs me I understand and agree that all employment offers are contingent upon successful completion of the pre-employment process that includes a comprehensive background check including criminal history and driving record check and an employment physical that may include a test to determine the presence of drugs andor alcohol in my body DATE Signature PAGE 55 DAY