Employment Application - Support Services
Operations: Driver, Scheduler, Assistant Transit Specialist, Operations Supervisor, etc. Non-Operations: Billing Specialist, Marketing/Outreach Coordinator, Administrative Assistant, Assistant Operations Director, etc.
Position Title:
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Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Secondary Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Drivers License #:
*
Drivers License State:
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Social Security Number
*
Date Available
*
-
Month
-
Day
Year
Date
Names & Birthdates of Children Who Have Lived With You (Background Requirement):
*
Are you a Citizen of the United States
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YES
NO
NO - Authorized to work in the U.S.
Have you ever worked for this company?
*
YES
NO
If so, when?
Have you ever been convicted of a felony?
*
YES
NO
If yes, explain:
*
Do you use tobacco products?
Cigarettes
Chew
Vape
I do not use tobacco products.
Desired Salary
Education
High School-Name:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Did you graduate?
YES
NO
College- Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Degree:
Date of Attendance:
Did you graduate?
YES
NO
REFERENCES
Please list three professional references
Name
First Name
Last Name
Relationship
Company
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Name
First Name
Last Name
Relationship
Company
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Name
First Name
Last Name
Relationship
Company
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Previous Employment
Company #1
Name of Supervisor
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Job Title
Starting Salary
Ending Salary
Responsibilities
Dates of Employment
Reason for leaving?
May we contact your previous supervisor as a reference?
YES
NO
Company #2
Name of Supervisor
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Job Title
Starting Salary
Ending Salary
Responsiblities
Dates of employment:
Reason for Leaving?
May we contact your previous supervisor for a reference?
YES
NO
Company #3
Name of Supervisor
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Job Title
Starting Salary
Ending Salary
Responsibilites
Dates of employment:
Reason for leaving?
May we contact your previous supervisor for a reference?
YES
NO
MILITARY SERVICE
Branch:
Dates of Service:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
Do you have a Smartphone?
YES
NO
What kind of phone is it?
IPHONE
ANDROID
GOOGLE
OTHER
Do you know how to use an iPad?
Yes
No
Some
How did you hear about Open Plains Transit?
Indeed
Social Media
Referral
Other
DISCLAIMER AND SIGNATURE
Submission of this form certifies that my answers are true and complete to the best of my knowledge.If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature:
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Submit
Should be Empty: