Application for Employment (Non-CDL Positions)

Application for Employment (Non-CDL Positions)

Cambria County Transit Authority | 502 Maple Avenue | Johnstown, PA 15901
Instructions: Thank you for your interest in employment with the Cambria County Transit Authority. Please complete all sections of this employment application to be considered for employment. We are an equal opportunity employer.
Section 1:

Personal Information
Name *

First Name Middle Initial Last Name Suffix
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Social Security Number *
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Please list all addresses where you have resided in the past 3 years:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

+ Additional Addresses
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Section 2: Desired Employment
Section 2:

Desired Employment
Desired Position *

Customer Service Reservationist (Part-time)
Available Start Date and Compensation Desired *

Available Start Date Compensation Desired
Have you ever applied for employment at this company before? *

Yes No
Position applied for *
Date Applied *

Month Day Year
Have you ever worked for this company before? *

Yes No
Position *
Start Date *

Month Day Year
End Date *

Month Day Year
Please list any other name under which you have been employed.
Are you legally authorized to work in the United States on an unrestricted basis for any employer? *

Yes No
Have you ever been convicted of a felony? *

Yes No
If yes, please explain: *

Section 5: Driver Information
Section 5:

Driver Information

Driver's License Information: If a driver’s license is required to be held for the position to which you are applying, please provide your driver’s license information.

State

License Number

Type (Class)

Expiration Date

Endorsement

Driver's License

Have you had any accidents in the past 3 years? *

Yes No

Accident record for the past 3 years or more

Date

Nature of Accident (Head-on, Rear-end, Upset, etc)

Fatalities?

Injuries?

Last Accident

Next Previous

If needed, please provide additional information

Traffic Convictions and Forfeitures for the past 3 years (Other than parking violations)

Location

Date

Charge

Type of Vehicle Operations

Last Conviction

Next Previous

If needed, please provide additional information here
If the answer to any of the questions below is Yes, please provide additional details in the box below.
Have you ever been denied a license, permit or privilege to operate a motor vehicle? If you answer “yes”, you much attach a statement giving details.

Yes No
Have any license, permit or driving privilege ever been suspended or revoked?

Yes No
Additional Details
For the past 2 years, have you tested positive or refused to test on any pre-employment drug or alcohol test required by a DOT-regulated employer because you would perform safety-sensitive transportation work?

Yes No
If you answered “yes”, you must identify the DOT-regulated employers and when the testing took place in the space below.
You must provide the Company with documentation that you successfully completed the return-to-duty process required by the DOT regulations. Failure to provide this documentation to the Company within two (2) weeks or other time period determined by the Company will result in the withdrawal of any job offer/transfer.

Section 6: Acknowledgement, Certification, Authorization
Section 6:

Acknowledgement, Certification, Authorization
I, the applicant, certify that the entries and information set forth in this Application are true and complete to the best of my knowledge. I understand that deliberately entering false information will result in the withdrawal of any offer/transfer.
Signature *

Clear
Today's Date *

Month Day Year
PLEASE READ CAREFULLY BEFORE SIGNING. Initial where indicated and sign the reading all certifications and notices contained therein.
1. I certify that the information contained in this application for employment at the Company is correct and complete. I understand that any false or misleading statements or omissions made in this application or interview(s), whenever discovered are grounds for disqualification from further consideration or for dismissal from employment, regardless of how discovered.
2. I understand that if I am offered employment at the Company it is at-will and can be terminated at any time and for any reason with or without advance notice by myself or the company.
3. I understand and agree that only the Company has any authority to enter into any agreement to employ me for any specified period of time or to modify the terms and conditions of my employment. I agree that such an agreement must be in writing and signed by the Executive Director, and I will not rely upon any other representations regardless of the source.
4. I understand and agree that the Company may make a fully complete investigation of my personal employment history, and authorize any former employer, person, firm, corporation, school, government agency, or other entity to provide the Company with any information (including fact or opinion) they may have regarding me. In consideration of the Company’s review of this application, I release the Company and all providers of any information from any liability, which may arise as a result of furnishing or receiving this information. I understand and agree any employment offer or continued employment shall authorize the Company to provide truthful information (fact or opinion) regarding my employment to any potential or future employer and release and waive any claims against the company for truthfully communicating any such information to be potential or future employer.
5. I understand and agree that I may be required to submit to drug testing and complete a medical examination as part of my application for employment. I also understand and agree that I may be required to submit to additional medical examinations during my employment with the Company, provided that such examination is job-related and consistent with business necessity. I consent to such testing and authorize the physician conducting the examination and any laboratory testing, any specimen obtained by the physician or collection site to disclose the results of the examination and the laboratory test to the Company if requested. The Company will keep such results confidential and disclose the results only to persons who need to know where required by law. Also, I agree to fully cooperate and provide the company with any additional consent(s) and/or release(s) as required by the Company to investigate my employment application.
6. I agree that the Company may investigate and consider any criminal conviction record that I may have after it makes a conditional offer of employment. The Company may withdraw a conditional employment offer if I have a criminal conviction record which bears a rational relationship to the duties and responsibilities of the position for which I am applying.
7. I understand and agree that if offered employment by the Company I may be required to disclose military service information in accordance with the law, and that any such employment offer shall be dependent upon the receipt of satisfactory military record as determined by the Company.
8. If hired, I agree not to disclose or use confidential information belonging to prior employees and that I will inform the Company of any agreements that would limit my ability to work for the Company.
Initial Here *
Disclosure and Authorization to Obtain Consumer Reports and Driving Performance History

In order to evaluate you for hiring, promotion, reassignment, transfer, retention in employment, or other employment-related purposes, the Company may decide to obtain a consumer report bearing on your creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. However, no consumer report will be obtained by the Company for employment purposes without your prior written authorization. I hereby acknowledge that the Company has disclosed, in writing, that it may obtain a consumer report bearing on my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living for employment purposes. I hereby authorize the Company and its representatives and agents to obtain a consumer report bearing on my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living.

I hereby acknowledge and consent to the Company to obtain and review reports of driver history from states in which a license has been held in accordance with, but not limited to, 48 CFR Part 391. This consent shall be considered continuing, permitting for additional driver history inquiries as deemed necessary by the Company for the entire length of my employment with the Company.

Previous Employer Inquiries and Investigations

As required by 391.23, we will make investigative inquiries to previous DOT-regulated employers related to your employment history, drug and alcohol testing results, and accident history. We will use this information in our hiring decision. Pursuant to 391.23, you have the following rights with regard to responses received in these areas from previous DOT-regulated employers:
1. The right to review information provided by previous DOT-regulated employers:
2. The right to have errors in the information corrected by the previous employer; and for that previous employer to re-send the corrected information to the prospective employer;
3. The right to have a rebuttal statement attached to the alleged erroneous information, if you and the previous employer cannot agree on the accuracy of the information.
If you wish to review previous DOT-regulated employer information received in response to required inquiries, you must submit a written request to the prospective employer no later than 30 days after being employed or being notified of denial of employment. After making such written request, any information received will be provided to you within five days, unless no such information has been provided in response to required inquiries. For information on procedures to rebut information provided by previous DOT-regulated employers, see Title 49 of the Coded Federal Regulations (CFR), Part 391.23(j).

I hereby acknowledge and certify that I have read and understood these Authorizations and Notifications in this section of this Application for Employment.
Signature *

Clear
Print Name *
Today's Date *

Month Day Year
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Application for Employment (Non-CDL Positions)

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