Regional Transit Service

Regional Transit Service
Date _____________
APPLICATION FOR EMPLOYMENT
(PLEASE PRINT CLEARLY)
Location You’re Applying For: (Check off which subsidiary you’re applying for)
Access
Genesee
Orleans
Livingston
Seneca
Monroe
Wayne
Ontario
Wyoming
Position You’re Applying For: (Check all that apply)
Bus Operator
Administrative
Mechanic
Other
Position you are applying for: _________________________________________________________________________________
Part-Time
Are you available:
Full-Time
Days
Evenings
Split Shift
Weekends
PERSONAL
Name: ____________________________________________________________________________________________________
LAST
FIRST
Email Address: ___________________________________
MIDDLE
Telephone: ________________________________________
Present Address: ______________________________________
NO.
City/State/Zip: _____________________________________
STREET
How long have you lived here? _________ Year(s) Month (circle
____ one)
Previous Address: _____________________________________
NO.
City/State/Zip: _____________________________________
STREET
How long did you live here? _________ Year(s) Month ____
(circle one)
Yes
Have you filed an application with our company before?
Have you worked for our company before?
Yes
No If yes, give date:___________________________
No If yes, when: _________________________________________
N.Y. State Motorist ID No.: ____________________ Do you have a CDL?
Yes
No or CDL Permit?
Have you had a driver’s license from any state other than New York in the past three years?
Yes
Yes
No
No
If yes, where? _________________________________________
Are you legally eligible for employment in the United States?
Were you referred by a current employee?
Yes
Yes
No
No
Do you have any relatives employed at this company?
Yes
No If yes, give names:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
As an equal opportunity employer, Rochester Genesee Regional Transportation Authority and its subsidiary Regional Transit Service do not discriminate against
any applicant because of race, creed, color, sex, age,disability, national origin, or marital status.
E D U C AT I O N A L B A C K G R O U N D
SCHOOL
NAME & ADDRESS
COURSE OF STUDY
NO. OF YRS.
COMPLETED
GRADUATED
COLLEGE
Yes
No
BUSINESS
OR TRADE
SCHOOL
Yes
No
HIGH SCHOOL
Yes
No
TYPE OF DIPLOMA
OR DEGREE
REFERENCES
List at least 3 professional references. DO NOT use relatives.
Name/Relationship To You
Telephone Number
Years Known
PERSONAL HISTORY
Please give accurate, complete full-time and part-time employment record. Start with your current or most
recent employer. Job record MUST cover at least TEN years. YOU MUST LIST TIMES NOT WORKING AS WELL.
COMPANY NAME
TELEPHONE
(
STREET ADDRESS
1
CITY/STATE/ZIP
)
DATES (MONTH & YEAR)
FROM:
JOB TITLE/POSITION
START: $
NAME OF SUPERVISOR
WERE YOU DISCHARGED OR ASKED TO LEAVE?
TO:
PAY RATE
REASON FOR LEAVING:
Yes
No
END: $
COMPANY NAME
TELEPHONE
(
STREET ADDRESS
2
CITY/STATE/ZIP
)
DATES (MONTH & YEAR)
FROM:
JOB TITLE/POSITION
TO:
PAY RATE
START: $
NAME OF SUPERVISOR
WERE YOU DISCHARGED OR ASKED TO LEAVE?
REASON FOR LEAVING:
Yes
No
COMPANY NAME
TELEPHONE
(
STREET ADDRESS
3
END: $
CITY/STATE/ZIP
)
DATES (MONTH & YEAR)
FROM:
JOB TITLE/POSITION
TO:
PAY RATE
START: $
NAME OF SUPERVISOR
WERE YOU DISCHARGED OR ASKED TO LEAVE?
REASON FOR LEAVING:
Yes
No
COMPANY NAME
TELEPHONE
(
STREET ADDRESS
4
END: $
CITY/STATE/ZIP
)
DATES (MONTH & YEAR)
FROM:
JOB TITLE/POSITION
TO:
PAY RATE
START: $
NAME OF SUPERVISOR
WERE YOU DISCHARGED OR ASKED TO LEAVE?
REASON FOR LEAVING:
Yes
No
COMPANY NAME
TELEPHONE
(
STREET ADDRESS
5
END: $
CITY/STATE/ZIP
)
DATES (MONTH & YEAR)
FROM:
JOB TITLE/POSITION
PAY RATE
START: $
NAME OF SUPERVISOR
WERE YOU DISCHARGED OR ASKED TO LEAVE?
TO:
REASON FOR LEAVING:
Yes
No
END: $
COMPLETE THIS SECTION ONLY IF A DRIVER’S LICENSE IS REQUIRED FOR THE POSITION YOU ARE SEEKING.
Have you been convicted of any moving violations in the last 10 years? (speeding, red light, seat belt, etc.) or any other
which caused a fine and/or points on your license?
Yes
No
If yes, list date(s) and charge(s):
Date(s)
Charge(s)
P L E A S E R E V I E W Y O U R A P P L I C AT I O N . A L L Q U E S T I O N S M U S T B E A N S W E R E D C O M P L E T E LY A N D T R U T H F U L LY.
AN INCOMPLETE APPLICATION MAY NOT RECEIVE FURTHER EMPLOYMENT CONSIDERATION.
I hereby certify that the facts set forth above are true and complete to the best of my knowledge.
I understand that if I am hired, false statements on this application will be considered suffcient cause for dismissal.
Signature of Applicant _______________________________________________________ Date _________________________
As an applicant, the information requested below is strictly voluntary. Your assistance in completing this form
will help RTS fulfill reporting obligations to comply with various government regulations.
This information will not be shared with hiring managers.
Gender:
Female
Male
Ethnicity: Please choose one:
American Indian/Alaskan Native
Black/African American
Native Hawaiian/Other Pacific Islander
Asian
Hispanic/Latino
White/Caucasian
Two or more ethnicities
(Not Hispanic or Latino)
How did you hear about this position?
Newspaper
Placement Office
Company Employee
Website
Professional Publication
Other
Job Fair
Those hired who decline to self-identify in the first box above may be identified by the Regional Transit Service using visual observation as permitted by Federal Law.