Employment Application

How did you learn about us? How did you learn about us? Advertisement Friend Walk-in Employment Agency Relative Other

Position(s) Applied for:

Last Name

First Name

Middle Name

Email Address

Street Number

Street

City

State

ZIP

Telephone Number(s)

Message Phone

Social Security Number

If you are under 18 years of age, can you provide required proof of your eligibility to work? If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No

Have you ever filed an application with us before? Have you ever filed an application with us before? Yes No

If Yes, give date:

Have you ever been employed with us before? Have you ever been employed with us before? Yes No

If Yes, give date:

Are you currently employed? Are you currently employed? Yes No

May we contact your present employer? May we contact your present employer? Yes No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment.) Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment.) Yes No

On what date would you be available for work?

Are you available to work: (Check all that apply) Are you available to work: (Check all that apply) Full Time Part Time Shift Work Temporary

Are you currently on lay-off status and subject to recall? Are you currently on lay-off status and subject to recall? Yes No

Can you travel if a job requires it? Can you travel if a job requires it? Yes No

Are you currently under arrest or have you ever been convicted of a crime? (Conviction includes guilty & no contest pleas and determinations of guilt under the Uniform Code of Military Justice.) Current arrests and convictions will not necessarily disqualify an applicant from employment. See CTA Policy Statement for more information Are you currently under arrest or have you ever been convicted of a crime? (Conviction includes guilty & no contest pleas and determinations of guilt under the Uniform Code of Military Justice.) Current arrests and convictions will not necessarily disqualify an applicant from employment. See CTA Policy Statement for more information Yes No

If Yes, please explain

I have read this CTA Policy. (Initial Here)

Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you have applied for, but did not obtain, safety sensitive transportation work covered by DOT agency Drug & Alcohol testing Rules during the past two years. [CFR 49, PART 40.25(j)] Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you have applied for, but did not obtain, safety sensitive transportation work covered by DOT agency Drug & Alcohol testing Rules during the past two years. [CFR 49, PART 40.25(j)] Yes No

If Yes, please explain

Driver’s License #

State

When applying as a Driver or in the Maintenance area, depending on the position, you must have or pass the Mississippi Commercial Drivers License (CDL) Class “B” with “P” endorsement with no air brake restriction. Do you presently have this * When applying as a Driver or in the Maintenance area, depending on the position, you must have or pass the Mississippi Commercial Drivers License (CDL) Class “B” with “P” endorsement with no air brake restriction. Do you presently have this * Yes No

I authorize a Motor Vehicle Report to be run as a prospective employee. (Initial here)

Name

Phone

Address

City

State

ZIP

I understand that a urinalysis drug screen will be a part of the examination as required by Federal Transit Administration regulations 653.41 Please Initial

Name

Social Security Number

Signature SaveClear

Date

High School High School 7 8 9 10 11 12

College College 1 2 3 4 5 6

Type of Degree:

Type of Degree

Typing Speed (WPM):

Business Machines Used:

Other Skills, certificates, or training that we should consider: