REQUEST FOR REASONABLE ACCOMMODATION IN
APPLICATION FOR EMPLOYMENT WITH
CEDAR VALLEY SERVICES, INC.

Reasonable accommodations are provided upon request. If you need assistance in applying for employment with Cedar Valley Services at any point in the employment application process (e.g., job description, completing employment application form, at the time of interview), please complete the following information and send this form to the following address:

Cedar Valley Services, Inc.

2111 4th Street NW

Austin, MN 59912

Telephone: 507-433-2303; TTY: 507-433-0868

Fax: 507-433-8880

Or e-mail to hnewman@cedarvalleyservices.org

Requests need to be made as soon as possible before the closing date of the specified period for the job opening.

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Two or More Races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.

THIS SECTION FOR CDL DRIVERS ONLY

THIS SECTION FOR CDL DRIVERS ONLY

THIS SECTION FOR CDL DRIVERS ONLY

ALL APPLICANTS COMPLETE

DRIVERS LICENSE

In signing this application for employment, I understand that misrepresentation or omission of facts is cause for cancellation of this application or separation from the company’s service if I am employed. I agree that the company shall not be liable in any respect if my employment is terminated because of falsity of statements, answers, or omissions made by me on this application. I understand also, that I
am required to abide by all rules and regulations of the employer.

I understand further that information concerning my past record will be sought from my previous employers and other sources and I hereby release from all liability or damages those individuals, corporations, or organizations, who provide such information.

If offered employment, I consent to taking a physical examination as may be required by the company. I understand that an offer of employment to me will be conditional on successful completion of a physical exam for the position I am applying. I agree to wear or use protective clothing or devices as required by the company and to comply with the safety rules.

I agree that the entire contents of this application form as well as the report of any such examination may be used by the company to whatever manner it wishes.

I hereby acknowledge that employment relationship with this company is of an “at will” nature, which means that the employee may resign at any time and the employer may discharge an employee at any time with our without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of the company. 

In support of my application for employment with Cedar Valley Services/SMART Transit, Austin, Owatonna, Albert Lea or Waseca Divisions, I hereby authorize my former employer(s), educational institution(s), and any and all other references given to release information about my employment, grades, and educational achievements, and other information as may be appropriate for employment consideration. This may include, but not be limited to, completion of a standardized reference form. A copy of this form shall serve as well as an original.

THE FOLLOWING QUESTIONS ARE REQUIRED FOR SMART APPLICANTS ONLY.

(DO NOT FILL OUT THE FOLLOWING UNLESS YOU ARE APPLYING FOR A SMART BUS DRIVER).

FOR DRIVER APPLICANTS OF COMMERCIAL MOTOR VEHICLES THAT REQUIRE A COMMERCIAL DRIVERLICENSE (CDL) THE APPLICANT MUST DISCLOSE THEIR CONTROLLED SUBSTANCE AND ALCOHOL STATUS PER THE REQUIREMENTS OF 49CFR PART 40.25(J).

As a prospective driver employee, you have the right to review information provided by previous employers. You have the right to have errors in the information corrected by the previous employer(s) and for that previous employer(s) to re-send the corrected information to the prospective employer; the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

Driver employees who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer provided information, must submit a written request to the prospective employer, which may be done at any time, including when applying or as last as thirty (30) days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five (5) business day deadlines will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived their request to review the records.

Certification

"I certify that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge."