EMPLOYMENT HISTORY
REMINDER: ITEMS WITH RED TEXT AND/OR BORDERED IN RED ARE REQUIRED FIELDS

Provide the following information of your past and current employers (past 7 years) for assignments, or volunteer activities, starting with the most recent. Explain any gaps in employment in comments section below:

Start Date (mm yyyy)

End Date (mm yyyy)

Hourly Rate/Salary

Hourly Rate/Salary

Start Date (mm yyyy)

End Date (mm yyyy)

Hourly Rate/Salary

Hourly Rate/Salary

Start Date (mm yyyy)

End Date (mm yyyy)

Hourly Rate/Salary

Hourly Rate/Salary

Start Date (mm yyyy)

End Date (mm yyyy)

Hourly Rate/Salary

Hourly Rate/Salary

SKILLS and QUALIFICATIONS
REMINDER: ITEMS WITH RED TEXT AND/OR BORDERED IN RED ARE REQUIRED FIELDS

List professional, trade, business, or civic associations and any offices held:

PLEASE NOTE: Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard, or any other similarly protected status.

PLEASE NOTE: Exclude any accomplishments, awards, etc. that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard, or any other similarly protected status.

AFFIRMATIVE ACTION INFORMATION

We consider all applicants for positions without regard to race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve/national guard or any other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria.

To be completed by applicant on a voluntary basis. Not of interview purposes. To be filed separately from application.

In an effort to comply with requirements regarding government record keeping, reporting and other legal obligations which may apply, we invite you to complete this applicant data survey. Providing this information is STRICTLY VOLUNTARY. Failure to provide it will not subject you to any adverse personnel decision or action. Your cooperation is appreciated.

Please be advised that this survey is not a part of your official application for employment. It will not be used in any hiring decision. The information will be used and kept confidential in accordance with applicable laws and regulations.

Referral Source:

Applicant Information:

Please check one of the following Equal Employment Opportunity Identification Groups:

ACKNOWLEDGEMENT
REMINDER: ITEMS WITH RED TEXT AND/OR BORDERED IN RED ARE REQUIRED FIELDS

I certify that all information I have provided in order to apply for and secure work with Central Texas Rural Transit District is true, complete, and correct.

I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to cancel further consideration of this application OR immediately discharge me from the employer’s service, whenever it is discovered.

I expressly authorize, without reservation, Central Texas Rural Transit District, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employees, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding Central Texas Rural Transit District , its agents, employees, or representative, for seeking, gathering, and using such information in the employment process and all other persons, corporations, or organizations for furnishing such information about me.

I understand that drug and alcohol testing is a requirement of employment with Central Texas Rural Transit District, City and Rural Rides, and that I will be subject to testing as a condition of employment. I also understand that all DOT employers are required to check on the drug and alcohol testing background of new hires and other employees beginning safety-sensitive work. CTRTD is required to get written consent from the applicant. CTRTD must send the request for information and the employee’s consent to all other DOT-regulated employers for whom I have worked within the previous two years. CTRTD cannot let the employee perform safety-sensitive duties for more than 14 days unless CTRTD has obtained, or made and documented a good faith effort to obtain this information. If CTRTD finds that I have a violation on my record and have not completed the return-to-duty process, CTRTD must immediately stop using me to perform safety sensitive functions.

I understand that the employer does not lawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state, or federal law.

I understand that this application is only for the current posted position and will be kept on file for 90 days.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of Central Texas Rural Transit District is authorized to make any assurance to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the General Manager or Assistant General Manager.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United State and that federal immigration laws require me to complete an I-9 form in this regard.

I acknowledge that I have received a copy of the position description for the position for which I am applying. I further acknowledge that I have read the position description and have been given the opportunity to ask any questions I may have regarding the duties, both physical as well as mental for this position. Based on the information provided me on the position description, I hereby attest to the following:

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

PLEASE NOTE
By entering your name in the box below, you are providing your electronic signature. In doing so, you agree that you are signing this document electronically and consent to all terms, conditions, and affirmations.

I certify that I have read, fully understand, and accept all terms of the foregoing applicant statement.

NOTICE TO APPLICANTS

Screening tests for illegal drug use is required as a condition of employment.