Employment Application Form

APPLICATION FOR EMPLOYMENT
Date

MonthDayYear
Instructions: Complete all necessary information. You may be asked to provide additional
information or another form. This application will be kept on file. It is to your advantage to
periodically check to keep it current and active. Be sure to sign and date the application.
Name:*

First NameLast Name
Social Security #
Phone Number:*

Area CodePhone Number
Email*
example@example.com
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position Applied for:*
Shift Preferred:
Special training or skills: (languages, machine operation, etc.) that would be of benefit in the job for which you are applying:
Would you accept part-time work?

YesNo
On what date would you be available to work?

MonthDayYear
Do you have a legal right to be employed in the U.S.?

Yes (proof is required)No
Are you of legal age to work?

YesNo
1. Have you previously worked for the Erie Metropolitan Transit Authority?

YesNo
If yes, please explain:
2. Do you possess a Pennsylvania Operators license?

YesNo
Type:

Class AClass BClass C
License #*
Endorsements:
Passenger, Airbrakes, etc.

	Name & Address of School	Course	Years Attended*	Did you graduate?
High School
College
Other

4. Office Applicants: (ONLY) Please indicate which of the following office equipment you can operate:

CalculatorShorthand/SpeedwritingComputer
Please list all software you are competent in:
Have you ever been convicted of a felony, misdemeanor in the last 7 years? Yes No (conviction will not necessarily disqualify an applicant from employment)

YesNo
Have you ever pled “Guilty” or “no contest” to, or been convicted of a crime? Yes No

YesNo
If yes, please explain:
Applicants are not obligated to disclose sealed or expunged arrest conviction records.

ANSWERING “YES” TO THESE QUESTIONS DOES NOT CONSTITUTE AN AUTOMATIC BAR OF EMPLOYMENT, OTHER FACTORS SUCH AS DATE OF OFFENSE, SERIOUSNESS, AND NATURE OF THE VIOLATION, REHABILITATION, AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT.

Employment Experience – 10 Year(s) History

Starting with your present or last job. Include any job-related, military service assignments and volunteer activities. You may exclude organizations, which indicate race, color, religion, gender, national origin, disabilities or other protected status.
Upload Resume:

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1.
Employer
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Telephone Number*

Area CodePhone Number
Dates Employed

MonthDayYear
MonthDayYear
Years Worked:*
Hourly Rate/Salary
Work Performed:*
Reason for Leaving:
2.

N/A
Employer
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone Number*

Area CodePhone Number
Dates Employed

MonthDayYear
MonthDayYear
Years Worked:*
Hourly Rate/Salary
Work Performed:*
Reason for Leaving:
3.

N/A
Employer
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone Number*

Area CodePhone Number
Dates Employed

MonthDayYear
MonthDayYear
Years Worked:*
Hourly Rate/Salary
Work Performed:*
Reason for Leaving:
I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company’s rules and regulations and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or the company’s option. I also understand and agree that the terms and condition of my employment may be changed, with or without cause and with or without notice, at any time by the Company. I understand that no company representative other than its Executive Director, and then only when in writing and signed by the Executive Director, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreements contrary to the foregoing.
Applicant Signature*

Clear

NOTICE TO APPLICANTS

All applicants for employment must pass a drug urine test prior to employment. As part of your pre-employment evaluation, you are required to submit a urine specimen at a designated collection site. A driver’s license must be presented for proof of identity. Your specimen will be tested at a laboratory approved by the Department of Health & Human Services for the following substances.

Marijuana
Cocaine
Opiates
Phencyclidine (PCP)
Amphetamines

You must pass this drug test prior to employment. If you are selected for employment you may be subject to future urine testing on a random, unannounced basis, or when there cause to believe you have used prohibited substances, and following an accident or prior to return to duty if you fail to pass a drug test or undergo treatment for drug or alcohol abuse. If you are employed you will be required to report within five (5) days to the designated transit person any conviction for violation of a criminal drug statute.

Certification: I have read and understand this notice and agree to all the provisions thereof.
Applicant Signature*

Clear
Date/Time*

MonthDayYear
DateHourMinutesAM/PM Option

MOTOR VEHICLE RECORD AUTHORIZATION FORM

As a condition of employment I, {name} hereby authorize the Erie Metropolitan Transit Authority to obtain my Motor Vehicle Record, (MVR) for the purpose of evaluating my suitability for employment. In the event that I am hired by the Erie Metropolitan Transit Authority, I further authorize the Erie Metropolitan Transit Authority to request an MVR at any time during the course of my employment. I understand that my employment and continued employment may be based upon the results of my MVR.
Applicant Signature*

Clear
Date/Time*

MonthDayYear
DateHourMinutesAM/PM Option
Should be Empty:

APPLICATION FOR EMPLOYMENT

Employment Experience – 10 Year(s) History