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1 POSITION APPLYING FOR: : OPERATOR MAINTENANCE ADMINISTRATIVE INSTRUCTIONS: THIS APPLICATION MUST BE COMPLETED EVEN IF A RESUME IS SUBMITTED. You must complete an application form for each postion. If a question does not apply to you, write "NA." Mailed applications are to be addressed to: MISSOULA URBAN TRANSPORTATION DISTRICT, 1221 Shakespeare St., Missoula, MT NAME: ADDRESS: Last First Middle Street City State Zip PHONE: How many years have you lived at this address? How long have you lived in Missoula? Are you or any members of your immediate household, related to any employee of Mountain Line? Y N If yes, identify by name, relationship and department. HIGH SCHOOL VO-TECH OR OTHER UNDERGRADUATE COLLEGE/UNIVERSITY GRADUATE/ PROFESSIONAL School Name Location Years Completed Diploma/Degree Year Graduated Dates Attended (Optional) List all relevant skills: 1. Skills with office machines. (Copier, 10 key, Postage Meters, etc.). Please list date of test and words per minute: 2. Skills with personal computer (list programs):

2 3. Skills with other tools or equipment: 4. List other licenses, certificates, registrations, seminars, workshops, etc. related to the position that you are seeking: Drivers License Current License State: Type: List all states in which you have held a drivers license: Do you currently have Class B Type II License? If yes, State: Expiration: Air brake endorsement? Passenger endorsement? Do you presently have any points against your license? If yes, how many? Would you obtain a Montana Class B Type II License prior to training? List all motor vehicle accidents 3 years prior to the date of this application: List all motor vehicle violations 3 years prior to the date of this application: General Information Have you worked with us before? If yes, when? Have you ever been convicted of any crime? (exclude traffic offenses) If yes, describe in full: Who referred you to us? Have you had military experience in the US Armed Forces? What branch? Length of duty: Would you consent to a pre-employment physical at the company's expense? Would you consent to a pre-employment background and credit check if required? Are you physically and mentally fit to perform the requirements for the position for which you are applying? Have you ever tested positive for a DOT drug and / or alcohol test? Have you ever tested positive for a pre-employment drug test for a position for which you were not hired? Have you ever refused a pre-employment drug test for another DOT-regulated employer?

3 Experience Begin with your present or most recent job and list your work experience with emphasis on experience that is relevant to the position for which you are applying. Include military service & any volunteer work which has provided experience that would help you qualify. List each position as a separate promotion. This information must be completed even if a resume is submitted. List all periods of unemployment. You may attach an additional sheet if more room is needed. May we make an inquiry of your current employer? Y N May we make an inquiry of your previous employer(s)? Y N If no, would you be willing to explain Y N why in an interview? May we contact you at a later date? Y N Please specify when: PLEASE TE: Information obtained from previous employers and/or references is confidential.

4 Additional Information Please give any additional information which may more fully describe your qualifications and capabilities. This space may be used to continue descriptions of your education or experience. Personal References Name Address Occupation Telephone # be considered for a position vacancy, you must complete and submit this application to Missoula Urban Transportation District (Mountain Line) at 1221 Shakespeare, Missoula, MT 59802, on, or before the announced deadline date. We request that you complete an "Applicant Self-Identification Form." This form is voluntary and will be separated from your application upon submission. I hereby authorize Missoula Urban Transportation District to inquire as to my record with any or all of my former employers and references with the exception of, and understand that Missoula Urban Transportation District will suffer no liability as the result of such inquiries. I hereby guarantee the correctness of the attached information. The making of false statements will be sufficient cause for denying me consideration for employment or for dismissal from employment. As an Equal Opportunity employer, Missoula Urban Transportation District encourages applications from women, minorities, disabled individuals, and Vietnam era veterans, and complies with the state and federal equal opportunity and affirmative action regulations. Applicant access to the Missoula Urban Transportation District office limited by physical disability will be accommodated. Please call (406) This material is available in an alternate format upon request. I certify that this application is true and complete to the best of my knowledge. I am aware that falsifications or misrepresentations may disqualify me from consideration for employment with Missoula Urban Transportation District or, if hired, may be grounds for termination at a later date. I am aware that previous employers may be contacted as references. Please note: the MUTD is an Equal Opportunity Employer. Interviews are given on a competitive basis, using job-related factors, after a written application has been received and reviewed. Because of the large number of applications received, not everyone who applies for a vacant position will be interviewed. INCOMPLETE or UNSIGNED APPLICATIONS will T be considered. Signature Date

5 MISSOULA URBAN TRANSPORTATION DISTRICT APPLICATION SELF-IDENTIFICATION FORM This is a voluntary, confidential form which is kept separate from your application. The Missoula Urban Transportation District, as a federal contractor, used this form for obtaining applicant information needed to complete required periodic reports of job applicants by race/ethnic categories, sex, disability status, and status as a disabled and/or Vietnam Era Veteran. This information is analyzed to determine if our selection process assures equal employment opportunity. We appreciate your cooperation in providing the following information. Name: Sex: Male Female Last First MI Position applying for: Department: Please check if applicable: DISABLED Any person who has a physical or mental impairment which substantially limits one or more major life activities, has a record of such an impairment. "Major life activities" means functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning and working. DISABLED VETERAN A person entitled to disability compensation under laws administered by the Veterans Administration for disability rated at 30 per centum or more or a person whose discharge or release from active duty was for a disability incurred or aggravated in the line of duty. VIETNAM ERA VETERAN A person who served on active duty for a period of more than 180 days, any part of which occurred between August 5, 1964 and May 7, 1975, and was honorably discharged or released therefrom with other than a dishonorable discharge or was discharged or released from active duty for a service connected disability. Please check ONE of the following: WHITE (Not of Hispanic Origin) Europe, North Africa, or the Middle East. BLACK (Not of Hispanic Origin) A person having origins in one of the black racial groups of Africa. SPANISH (Hispanic) A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race. ASIAN OR PACIFIC ISLANDER of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, Samoa, and the Philippines. AMERICAN INDIAN OR ALASKAN NATIVE of North America, who maintains cultural identification through tribal affiliation or community recognition. Where did you learn about this vacancy? Newspaper Job Service Word of Mouth Other (posting, etc.) Signature: Date: Thank you for taking the time to complete this form. Please return it with your application to: Missoula Urban Transportation District, 1221 Shakespeare, Missoula, MT MUTD IS AN AFFIRMATIVE ACTION/EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER