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TITLE VI
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Employment Application
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Personal Data
Date of Application
*
MM slash DD slash YYYY
Name
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First
Last
First
Address
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Street Address
City
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Armed Forces Americas
Armed Forces Europe
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State
ZIP Code
Date of Birth
*
MM slash DD slash YYYY
Please enter your date of birth
Phone Number
*
Best number to reach you at
Email
*
Best email to reach you at
Have you ever been employed with TARTA?
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No
Yes
Please check one
If yes, when did you work for TARTA?
Are you interested in:
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Full-time
Part-time
Temporary Work
Split Shifts
Check check all that apply.
Are you available to work any day of the week, including weekends and holidays?
*
Yes
No
Please check one
Were you referred by a TARTA employee?
*
Yes
No
If referred, please lprovide Employee's full name
Are you legally authorized to work in the United States?
*
Yes
No
Please check one
Driving and Performance
This section is for individuals who are applying for a position which requires driving of TARTA owned vehicles or personally owned vehicles.
Do you carry a commercial Driver's License?
*
Yes
No
Please check one
Do you have a valid Driver's License?
*
Yes
No
Please check one
Driver's License Number
*
Please list the Driver’s License Number.
Driver's License State of Issue
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Please list the state your Driver’s License was issued. If no valid license, please list NA.
Date License Expiration Date
*
MM slash DD slash YYYY
Please list when your Driver’s License expires.
Have you ever had any moving violations?
*
Yes
No
Please check one
If you have had moving violations, please list how many.
Number of moving violations
Has your Driver's License any state, including Ohio, ever been suspended or revoked?
*
Yes
No
Please check one
If yes, please provide State, reason and year(s).
Haven you ever been in any traffic accidents since acquiring a driver's license?
*
Yes
No
Please check one
If yes, please describe, including month/year.
Have you been disciplined or dischared for any of the following?
*
Failure to Notify when absent or tardy?
Fighting or assault related offences?
Violations of safety rules?
Accidents?
Other?
None of the above
Please check one
If other, please describe
Describe discipline if other.
Medical Requirements
As a condition of employment, do you consent to taking a post-offer/pre-employment physical?
*
Yes
No
I understand my emplyment is subject to satisfactorily passinga drug screen
*
Yes
No
Another post-offer/ pre-employment requirement is a successful completion of employment and background checks. Do you agree to undergo these checks?
*
Yes
No
Have you ever tested positive or refused any alcohol or drug for a safety or non safety-sensitive position for which you were not hired?
*
Yes
No
I understand all TARTA employees are subject to further employment related screens?
*
Yes
No
Education
All credentials must be verified.
Name of High School
*
Location of High School
*
High School Diploma?
*
Yes
No
GED?
*
Yes
No
Name of College/University
Location College/University
College Graduate?
Yes
No
Degree Earned
Major
Are you planning further education, training, study, or certification?
*
Yes
No
Please choose one
If yes, please explain.
Have you ever served in the Armed Services of the United States?
*
Yes
No
Please choose one
If yes, please list branch and years
List any additional infonnation or special qualifications you have for the requested position(s):
Employment History – start with most recent job
Company
*
Name of the Company you worked for
Dates Employed
*
Please list the dates you were employed
Supervisor
*
Your direct supervisor
Company Phone
*
Company phone number
Company Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Please list your reason for leaving. NA if still employed.
Reason for leaving
*
Responsibilities
Previous Addresses
If previous address was in a different County, City or State that is different from your current address.
Address
Street Address
City
State / Province / Region
Disclaimers
Do you fully understand that the first ninety (90) days of your employment, beginning with your in-service date, will be probationary, which means that your continued employment will be at the discretion of TARTA?
*
Yes
No
Do you authorize TARTA to make any investigation/background checks TARTA considers necessary regarding your employment?
*
Yes
No
INSURABILITY: All TARTA safety-sensitive employees must maintain proper credentials at a level that qualifies for insurability under TARTA's insurance requirements at standard rates. Whenever, during the time of employment, an employee's record exceeds that point level threshold for insurability, I understand and agree I will be immediate! terminated.
*
Yes
No
Thank you for considering TARTA in your job search. Please review your application for completeness and accuracy. Make sure that all questions have been answered. TARTA will not accept an application for processing ifit is incomplete, illegible, and/or if the applicant does not meet the minimum qualifications. The time limitation for filing claims against TARTA is six (6) months from the date of application submission. Please place complaint in writing and mail (certified mail preferred) to TARTA's EEO Officer or Chief Executive Officer at P.O. Box 792, Toledo, OH 43697-0792. Applications are valid for six (6) months from the date of submission; if you wish to be reconsidered for employment after the six (6) months, you must re-apply. Per the Ohio Revised Code Statutory Definition (ORC 149.01 l(G), this application is considered a public record and as such is ovemed by the Ohio Sunshine Laws.
I have read and understood the above statement.
*
Yes
No
DISCLOSURE REGARDING BACKGROUND INVESTIGATION ON YOU TARTA ("the Company") may obtain "consumer reports" about you from a consumer reporting agency for employment purposes. A consumer report" is a background screening report that may contain information regarding your criminal history, sex offender registry status, credit history, employment history, education history, social media activity, workers comp history, driving history, professional licenses, and other information about you. It may bear upon your character, general reputation, personal characteristics, and/or mode of living.
I have read and understood the background investigation disclosure.
*
Yes
No
Acknowledgement & Signature
I certify that the statements made in this application and hiring process and all supporting documents are true and correct to the best of my knowledge. I understand and agree that any falsification, misstatement, or omission of fact, or illegal or illicit behavior statements made at any time, or failure to timely provide verification of information submitted on this application will result in disqualification of my application or termination of my employment whenever discovered.
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