GENERAL INFORMATION. Permanent Address: No. Street City State Zip

Size: px
Start display at page:

Download "GENERAL INFORMATION. Permanent Address: No. Street City State Zip"

Transcription

1 Transit Management of Denton County Human Resources Department 1101 Teasley Lane, Denton, TX Fax: APPLICATION FOR EMPLOYMENT (Staff) Thank you for considering applying for a position with TMDC. We appreciate the time you are giving to complete this application. It is important that you fully and accurately complete this form yourself and indicate the position(s) for which you wish to be considered. Please be very careful completing this application. We use a sophisticated and detailed background and employment screening process which will disclose inaccurate false and/or incomplete or omitted information. As a matter of policy and for the safety of the communities we serve, Transit Management of Denton County consistently applies background checking standards to all applicants. It is essential that all information requested including educational background, work, criminal and residential history is complete and accurate. This application will remain on file for one year from the date indicated on the signature page, after which time you should resubmit a new application if you are interested in a future position with TMDC. Instructions: Please type or print in ink. Answer all questions, checking all boxes that apply. Answer N/A on questions that do not apply. Additional forms may be attached, if needed. Date: GENERAL INFORMATION Name: Last First Middle Have you ever used another name? Yes No List all other names by which you have been known: Permanent Address: No. Street City State Zip Contact Telephone ( ) Alternate Phone ( ) Please list the cities and corresponding state you have lived in during the past 7 years: City, State City, State City, State City, State City, State City, State Position(s) Applying For: Minimum salary/wage requirement: Annually Hourly Date available to start: Are you able to perform, with or without reasonable accommodations, the essential functions of the job(s) you are seeking? Yes No Can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? Yes No Are you age 21 or over? Yes No Available to work: Full-Time Part-Time Would you be available to work overtime, if necessary? Yes No Please list your hours of availability below: Monday Tuesday Wednesday Thursday Friday Saturday 1 of 6

2 Have you ever applied to or worked for DCTA before? Yes No If yes, when? Do you have any friends or relatives working for DCTA? Yes No If yes, state name(s) and relationship(s): Do you have any commitment to another entity or person that might affect your employment with DCTA? Yes No If yes, describe fully: EDUCATION, TRAINING & EXPERIENCE No. of Years Degree or Did you School: Name and Address Completed Diploma Graduate? High School Yes No College/University Yes No Vocational/Business Yes No Do you speak, write or understand any foreign languages? Yes No If yes, which language(s): Typing: WPM Spread Sheet: Yes No Cash Handling: Yes No Ten Key: KPH Database: Yes No Multiline Phone: Yes No Shorthand: Yes No Word Processing: Yes No Dictaphone: Yes No Accounting Programs: Yes No If yes, please list: Graphic programs: Yes No If yes, please list: List any additional Computer Programs with which you are familiar: Do you have any other experience, training, qualifications or skills which you feel make you especially suited for work at DCTA? Explain below. 2 of 6

3 EMPLOYMENT HISTORY List all present and past employment for the last ten (10) years, starting with your most recent employer. You must complete this section even if attaching a resume. Attach additional pages, as needed. Name of Employer: Type of Business: Dates of Employment (mm/yy-mm/yy): Employer Address: City, State, Zip: Phone: Position(s) Held: Brief description of duties: ( ) / - / Direct Supervisor s Name: Reason for Leaving: Termination: Starting Wage: Ending Wage: Voluntary Involuntary Name of Employer: Type of Business: Dates of Employment (mm/yy-mm/yy): / - / Employer Address: City, State, Zip: Phone: Direct Supervisor s Name: ( ) Position(s) Held: Brief description of duties: Reason for Leaving: Termination: Starting Wage: Ending Wage: Voluntary Involuntary Name of Employer: Type of Business: Dates of Employment (mm/yy-mm/yy): / - / Employer Address: City, State, Zip: Phone: Direct Supervisor s Name: ( ) Position(s) Held: Brief description of duties: Reason for Leaving: Termination: Starting Wage: Ending Wage: Voluntary Involuntary Please list any gaps in employment below. Add additional pages, as needed. From: (mm/yy) To: (mm/yy) Reason: From: (mm/yy) To: (mm/yy) Reason: 3 of 6

4 CRIMINAL HISTORY Transit Management of Denton County and Denton County Transportation Authority strive to provide a safe environment for employees, the communities we support and the patrons we transport. For these reasons, all applicants must provide a complete adult criminal conviction record subject to federal and state mandated restrictions. This includes any conviction and/or criminal charge where the final disposition is still pending. Please note that a criminal conviction history will not necessarily disqualify an applicant from employment. Factors such as age, seriousness and nature of the violation as it relates to the applicable position shall be considered. Date of conviction or pending charge MM/ YYYY / Mark appropriate box Misdemeanor Felony Pending Charge Location of conviction or pending charge City State Nature of conviction or pending charge Name of court Date of conviction or pending charge MM/ YYYY Mark appropriate box Misdemeanor Felony Pending Charge Location of conviction or pending charge City, State Nature of conviction or pending charge Name of court Date of conviction or pending charge MM/ YYYY Mark appropriate box Misdemeanor Felony Pending Charge Location of conviction or pending charge City, State Nature of conviction or pending charge Name of court No applicant will be denied employment solely on the grounds that they have been charged, committed or been convicted [or pleaded guilty or nolo contendere] of a criminal offense; or, solely on an affirmative answer above. PROFESSIONAL REFERENCES List three individuals, not related to you, who have worked with you on a professional level and can provide information on your work performance. Name Address Phone Years Known An Equal Opportunity Employer 4 of 6

5 APPLICANT STATEMENT AND RELEASE By signing this application, I agree to the following statements. I certify that all information provided on this Application for Employment and in any subsequently executed questionnaire or employment document are true and correct. I understand that any material falsifications or omissions made on this application, or any pre-application document, may result in termination of my candidacy or any subsequent employment. Transit Management of Denton County/Denton County Transportation Authority (TMDC/DCTA) and its related entities are equal opportunity employers. I understand that the Company recruits, hires, and promotes employees without regard to race, color, religion, sex, age, national origin, citizenship, military status or disability. Individuals with disabilities who need assistance completing this application can contact the Human Resources Department to arrange suitable accommodations. I understand that in order to comply with the Federal Immigration Reform and Control Act, TMDC/DCTA requires all new hires to show proof of eligibility to work in the United States. If I fail to produce the required documents to Human Resources within the required time period, TMDC/DCTA will rescind any job offer and terminate my employment. I hereby authorize my prior employers, all educational institutions that I have attended, and all individuals whom I have listed as references herein, to provide TMDC/DCTA and its agents or designees, any and all information that they may have regarding my past employment, education, experience, and qualifications. I hereby authorize TMDC/DCTA to investigate and obtain any and all oral and documentary information regarding my past employment, education, experience, and qualifications. I hereby release and agree to indemnify and hold harmless TMDC/DCTA and all such prior employers, educational institutions, and individuals from any and all liability for providing any information regarding my past employment, experience, and qualifications. I hereby authorize TMDC/DCTA, and any third-party affiliates used for investigative purposes, to obtain my driving record and criminal record from federal, state or local authorities, the Department of Transportation (DOT) and/or the Federal Transportation Administration (FTA) for the purpose of reviewing my background and history relevant to the position(s) I have applied for. I request, authorize, and consent to the release of any and all such information to TMDC/DCTA consistent with state and federal laws and hereby release and agree to indemnify and hold harmless every person or entity that communicates such information to TMDC/DCTA from any and all liability for providing any information regarding my driving record or criminal record. I acknowledge that TMDC/DCTA is a drug-free workplace and that any offer of employment is contingent upon my submittal to a drug screen and the Company s receipt of satisfactory results of such testing, receipt of satisfactory background checks and, if necessary to determine ability to perform essential duties of the position offered, the satisfactory results of a physical examination. If an employer and employee relationship is established, I understand that either I or the company may terminate such employment at will at any time, for any reason, without cause, and with or without notice. 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. Applicant s Printed Name Date Applicant s Signature An Equal Opportunity Employer 5 of 6

6 APPLICANT EEOC DATA (Optional) The information requested is being collected for the purpose of reporting to Federal and Equal Employment Opportunity Agencies and will not be considered as part of the application for employment. It will be separated from the application upon submittal to Human Resources. Position Applied For: Date of Application: Last Name: First Name, Middle Initial: (Check mark preferred for all of the following categories) Gender Male Female Ethnic Origin White Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander America Indian or Alaskan Native Asian Two or More Races (Not Hispanic or Latino) All persons who identify with more than one of the above five races. Veteran Yes No Surviving Spouse of Veteran who has not remarried How did you first find out about this job? Yes DCTA employee Radio No Recruitment Poster Television Orphan of Veteran Yes No College/University Career Day Web Site Internet Other (specify): Newspaper Signature Applicant Date An Equal Opportunity Employer 6 of 6