Employment Application

What position are you applying for?*

DriverBus AideOffice
What Date can you start? *

MonthDayYear
Date
Hours of Availability: Days Availble (i.e. M-F) Hours Availble (i.e 6am-6pm)
Hourly rate desired: $ per hour *

Education:

Please describe secondary and post-secondary courses and training which have given you work-related skills or knowledge:
Institution Name:   *
Location:   City, State*
Dates attended:   Year*   to   Year*
Area of study:   *
Did you graduate:   *
Institution Name:
Location:   City, State
Dates attended:   Year   to   Year
Area of study:
Did you graduate:
List special skills, professional license or certification relative to this position:
Experience with special needs children or adults, driving, training, etc.

Employment history:

List below 3 most recent employers, starting with your most recent or current employer
Are you currently employed?*

YesNo
If yes, may we contact your current employer?*

YesNo
Current or most recent employer:
Company Name:   *
Location:     City, State
Position:   Job title or duties*
Dates of employment:   MM/YYYY*   to   MM/YYYY*
Supervisor name:   *
Phone number:
Reason for leaving:   Be specific*
Next most recent employer:
Company Name:   *
Location:   City, State*
Position:   Job title or duties*
Dates of employment:   MM/YYYY*   to   MM/YYYY*
Supervisor name:   *
Phone number:   *
Reason for leaving:   Be specific*
Next most recent employer:
Company Name:   *
Location:     City, State*
Position:   Job title or duties*
Dates of employment:   MM/YYYY*   to   MM/YYYY*
Supervisor name:   *
Phone number:   *
Reason for leaving:   Be specific*
If there are any gaps in your employment history, please explain:
Be specific
Do you have any professional driving experience? If yes, how many years, and where at? *

References
Reference #1:
Name:   First and Last Name*
Location:   City, State*
Phone number:
Relationship:   Friend, Mentor, Co-worker, teacher, etc. *
Years Acquainted:   *
Reference #2:
Name:   First and Last Name*
Location:   City, State*
Phone number:
Relationship:   Friend, Mentor, Co-worker, teacher, etc. *
Years Acquainted:   *
Reference #3:
Name:   First and Last Name*
Location:   City, State*
Phone number:   *
Relationship:   Friend, Mentor, Co-worker, teacher, etc. *
Years Acquainted:   *

Referral information
How did you hear about us?*

AdvertisementReferralLinked InI have used, or know someone who has used your services.Other
Have you ever worked for Contemporary Transportation before? If yes, When?
Do you know anyone who works for Contemporary Transportation? If yes, who?
Do you have an interview scheduled with Us?*

YesNoOther
If yes, What date/time? If No, what days/times work best for you? *
Please arrive to your scheduled interview 10 minutes

Driving Record - Driver Applicants ONLY

Select 'Next' if you are applying for a non-driving position
Accident Record:
List and describe any motor vehicle accidents in the last 3 years
Traffic Convictions:
List and describe any moving violations in the last 3 years
Have you ever been denied a license, permit or privilege to operate a motor vehicle?*

YesNo
If you are applying for a driving position, do you have a valid DOT card?

YesNo
If you DO have a valid DOT card please bring it with to the interview.

Background Checks Information:

(If the field does not apply put N/A)

Full Legal Name: {fullLegal}
Date of Birth: {dateOf}
Social Security Number:   xxx-xxx-xxxx
Race:  {howDo}
Sex:   On license or ID
COUNTRY of birth:
If the USA, What State:
Are you a US Citizen?   YES   NO
Eye Color:   on license or ID   Hair Color:   Brown, Blonde, Red, etc.
Height:         Weight:   lbs
Do you have a valid Driver's license? {doYou}
Driver's License #:
DL Issue Date:Date   Expiration Date:Date
State:         Class:
Have you lived out of the state of MN in the past 5 years?   Yes   No
If yes, Please list the City, state, and which years you lived there:   City, State; YYYY-YYYY   City, State; YYYY-YYYY   City, State; YYYY-YYYY
Cell phone number: {cellPhone}
Home phone number: {phoneNumber6}
Email: {email}
Current address: {address}
Mailing address, if different from Above:    House Number, Street, City, State, Zip
Have you ever been known by any other legal names:   Yes   No
If yes, Please list the name(s):
First and last Name
First and last Name
First and last Name
I understand, if I did not fill this form out online, I should arrive 15 min prior to my interview to complete it in the office.*

YesOther

Please read all areas carefully before signing.

There are a number of required checks that must be done for every prospective employee

I certify that the information which I have provided in this application is true and complete to the best of my knowledge and that I have withheld no information or other response that would if disclosed, affect this application unfavorably. I understand that any misleading or incorrect statements or responses may render this application void and may result in the immediate cancellation of my agreement regardless of the point in time at which the misleading or incorrect
statement or response was discovered.

I understand that Contemporary Transportation LLC may conduct an investigation concerning my character, general reputation, employment history, job performance, criminal records, motor vehicle records, and any other required checks to be approved by the various state organizations to perform this job. I authorize Contemporary Transportation LLC to obtain, and any person, corporation, or governmental unit whom Contemporary Transportation LLC contacts to release to Contemporary Transportation LLC all information known to them regarding my character, general reputation, employment history, job performance, criminal records, motor vehicle records, and other qualifications, whether or not it is in their records. I hereby release Contemporary Transportation LLC and all persons, corporations, governmental units, and law enforcement agencies contacted by Contemporary Transportation LLC from any and all liability for any damage flowing from the disclosure of this information and Contemporary Transportation LLC’s action thereon.

The investigation will include using the Minnesota Department of Public Safety/BCA Web site as one of the background checks conducted. I authorize the Minnesota Bureau of Criminal Apprehension and the Minnesota Department of Human Services to disclose all criminal history record information to Contemporary Transportation LLC for the purpose of employment.

I agree to submit myself, whenever requested by Contemporary Transportation LLC in accordance with the Company’s policies to physical examinations by medical personnel designated by Contemporary Transportation LLC and to testing for the presence of alcohol and other drugs or substances by medical personnel designated by Contemporary Transportation LLC. I understand and agree that any positive test result or the refusal to submit to such testing may result in disciplinary action up to, and, including termination as per the Company’s drug and alcohol testing policy. I understand that an offer of employment will be contingent upon my submitting to a drug test and receiving a negative test result. I further understand that employees may be subject to drug testing throughout their employment. I hereby agree to drug testing as required by Contemporary Transportation LLC policy and release Contemporary Transportation LLC from all liability arising from such testing and/or decisions made based on such testing. My signature constitutes permission for Contemporary Transportation LLC drug testing according to policy and a waiver of all liability arising from such testing. Testing is done in accordance with DOT regulations.

I acknowledge that Contemporary Transportation LLC reserves the right to inspect all property (including vehicles, purses, lockers, desks, lunch boxes, packages, briefcases, and other containers) on Contemporary Transportation LLC’s premises and I agree to allow and to allow and to cooperate with such inspections. I also agree that Contemporary Transportation LLC has permission to photograph me and to utilize the photographs in furtherance of Contemporary Transportation LLC business. I understand that Contemporary Transportation LLC and its employees will from time to time, monitor my performance and activities under the agreement while I am working or while I am on Contemporary Transportation LLC property, by electronic, video and/or voice transmittal and receiving equipment, and other monitoring devices. Contemporary Transportation LLC has my permission to engage in such monitoring and I fully release and hold harmless Contemporary Transportation LLC, its officers, employees, and agents of any claim or complaint and damages whatsoever that I may have against them relating to, directly or indirectly, to this monitoring activity.

I further acknowledge and understand that Contemporary Transportation LLC has the unilateral right, at any time, and for any reason, to terminate my employment with or without notice. I further, understand and agree that my employment is not for any specific term or period of time, and that Contemporary Transportation LLC may terminate my employment with or without cause, with or without notice, and without further obligation to me, at the sole and absolute discretion and will of Contemporary Transportation LLC. I understand that no representative of Contemporary Transportation LLC, other than the Vice President, General Manager, or Terminal Manager has any authority to enter into any agreement for a specified period of time, or to make any agreement contrary to the foregoing; and then only be a written individual employment agreement signed by the Vice President.

I understand that the Company’s receipt of this application does not entitle me to an agreement to become an employee. This application will be considered only for the position for which I apply and will become void and no longer be considered sixty calendar days from the date of this application. The authorization to run the background checks will also expire 60 days from the date of this application unless I am hired in which case, the checks are done on a regular basis by different agencies listed herein.
Signature*

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We will use the information provided in the "Background Checks information" section to complete a DHS Net study for you. Please see the DHS Background Study Notice of Privacy Practices below.
You signature confirms you have received the DHS Background study notice of privacy practices. *

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Employment Application

Education:

Employment history:

References

Referral information

Driving Record - Driver Applicants ONLY