Application (Driver-Mechanic)

Area Transportation Authority of North Central Pennsylvania an Equal Opportunity Employer (M/F) 44 Transportation Center, Johnsonburg, PA 15845-2102

Please complete this application with as much information as possible. Our Human Resources Representative will contact you for additional information if needed.

[click here] to download the PDF and print the application.

Email(*)

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Position Applied for:(*)

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Date of Application:(*)

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Name: (Last, First, Middle)(*)

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Current Address: (Please list street address, City, State, Zip and how long you have lived there)(*)

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Address in Past 3 Years: (Please list street address, City, State, Zip and how long you lived there for EACH)(*)

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Telephone:(*)

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Cell Phone:

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If employed, when can you begin work?

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Date of Birth:(*)

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Do you hold a valid Pennsylvania Driver’s License?(*)

YESNO Invalid Input

Are you a U.S. Citizen?(*)

YESNO Invalid Input

Have you worked for this Company before?(*)

YESNO Invalid Input

If so, where

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Please list dates, rate of pay, position and reason for leaving:

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Does this agency currently employ any member of your immediate family?(*)

YESNO Invalid Input

Names of relatives in our employ

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Does any member of your immediate family currently serve on the Board of Directors of this Authority?

YESNO Invalid Input

Name(s) of relatives on the Board

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Are you currently employed? If not, how long since leaving last employment?

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MILITARY STATUS

Have you served in the U.S. Armed Forces?

YESNO Invalid Input

Branch

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Date joined:

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Rank at Discharge

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Date of Discharge:

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Type of Discharge

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Draft Status

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Reserve Status

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EDUCATIONAL RECORD

High School (Last grade / year completed):

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College (Last grade / year completed):

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Last School Attended: (Name, City, State)

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Have you ever been denied a license, permit or privilege to operate a motor vehicle?

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Has any license, permit or privilege ever been suspended or revoked?

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If the answer to either A or B is yes, please provide a statement giving details

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Experience & Qualifications: List types of vehicles or equipment operated; types and years of driving or maintenance experience; any specialized training, certifications, and awards.

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EMPLOYMENT FOR THE PAST 10 YEARS

List your complete employment record. Include periods of unemployment, starting with your present or last position and work back.

Job #1 Information

Dates Employed: (From [MM/DD/YYYY] - To [MM/DD/YYYY])

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Name and Address of Company:

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Position Held:

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Starting Salary: (Include amount and for what period of time. IE: weekly, annually, etc.)

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Ending Salary: (Include amount and for what period of time. IE: weekly, annually, etc.)

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Immediate Supervisor Name & Phone Number:

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Fully describe your major duties and responsibilities:

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Reason for leaving:

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Job #2 Information

Dates Employed: (From [MM/DD/YYYY] - To [MM/DD/YYYY])

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Name and Address of Company:

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Position Held:

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Starting Salary: (Include amount and for what period of time. IE: weekly, annually, etc.)

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Ending Salary: (Include amount and for what period of time. IE: weekly, annually, etc.)

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Immediate Supervisor Name & Phone Number:

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Number of Hours Worked each week:

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Fully describe your major duties and responsibilities:

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Reason for leaving:

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Job #3 Information

Dates Employed: (From [MM/DD/YYYY] - To [MM/DD/YYYY])

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Name and Address of Company:

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Position Held:

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Starting Salary: (Include amount and for what period of time. IE: weekly, annually, etc.)

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Ending Salary: (Include amount and for what period of time. IE: weekly, annually, etc.)

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Immediate Supervisor Name & Phone Number:

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Number of Hours Worked each week:

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Fully describe your major duties and responsibilities:

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Reason for leaving:

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Have you ever been convicted of a misdemeanor or felony (excluding minor traffic violations)?

YESNO Invalid Input

If yes, explain (Include Location, Date, Charge and Penalty for each)

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A false or dishonest answer to any question on this application will be grounds for rating you ineligible for employment. All statements on this application are subject to investigation including a police check, motor vehicle records check, checks of salaries, references, and former employers. All data will be considered in determining your eligibility for employment with this Authority.

ACCIDENT RECORD

Accident Record for past 10 years or more (include all motor vehicle accidents.) List in reverse chronological order (most recent accident first, etc.)

List Accidents for the past 10 years: Please include DATES, NATURE OF ACCIDENT, NUMBER OF FATALITIES, and NUMBER OF INJURED.

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TRAFFIC CONVICTIONS

Traffic convictions and forfeitures of bond or collateral in past 10 years (other than parking violations.) List in reverse chronological order (most recent event first, etc.)

List traffic convictions and forfeitures of bond or collateral in past 10 years: PLEASE INCLUDE - DATES, LOCATION, CHARGE and PENALTY.

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CHECK THE BOX if You acknowledge the above statement and You certify that the statements contained herein are accurate and true to the best of your knowledge, information, and belief.

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(*)

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Employment Application (Driver / Mechanic)