Employment Application Step 1 of 9 - Applicant Information 11% Applicant InformationName* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Date Available* MM slash DD slash YYYY Desired SalaryPosition Applied For*Are you a citizen of the United States?* Yes No Are you authorized to work in the U.S.?* Yes No Have you ever worked for this company?* Yes No When did you work for this company?*Have you ever been convicted of a felony?* Yes No If yes, explain.*Upload Your ResumeMax. file size: 10 MB. EducationHigh SchoolHigh SchoolAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code From MM slash DD slash YYYY To MM slash DD slash YYYY Did you graduate? Yes No DegreeCollegeCollegeAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code From MM slash DD slash YYYY To MM slash DD slash YYYY Did you graduate? Yes No DegreeOther EducationOtherAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code From MM slash DD slash YYYY To MM slash DD slash YYYY Did you graduate Yes No Degree ReferencesPlease list three professional references.Reference 1Reference 1 Name* First Last RelationshipCompanyPhone*Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Additional InformationReference 2Reference 2 Name First Last RelationshipCompanyPhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Additional InformationReference 3Reference 3 Name First Last RelationshipCompanyPhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Additional Information Previous EmploymentCompany 1CompanyPhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name First Last Starting SalaryEnding SalaryJob TitleResponsibilitiesFrom MM slash DD slash YYYY To MM slash DD slash YYYY Reason for LeavingMay we contact your previous supervisor for a reference? Yes No Additional InformationCompany 2CompanyPhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name First Last Starting SalaryEnding SalaryJob TitleResponsibilitiesFrom MM slash DD slash YYYY To MM slash DD slash YYYY Reason for LeavingMay we contact your previous supervisor for a reference? Yes No Additional InformationCompany 3CompanyPhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name First Last Starting SalaryEnding SalaryJob TitleResponsibilitiesFrom MM slash DD slash YYYY To MM slash DD slash YYYY Reason for LeavingMay we contact your previous supervisor for a reference? Yes No Additional InformationIn the past two years, have you been employed by a Department of Transportation (DOT) regulated employer?* Yes No Do you hereby allow Muncie Indiana Transit System to contact your former Department of Transportation (DOT)-regulated employer(s), from the past two (2) years, to request and receive information in accordance with 49CFR part 40.25, as indicated below?* Yes No 1. Alcohol test results of .04 or higher alcohol concentration. 49CFR part 40.25 (b)(1) 2. Verified positive drug tests. 49CFR part 40.25 (b)(2) 3. Refusals to be tested (including verified adulterated or substituted drug test results) 49CFR part 40.25 (b)(3) 4. Other violations of DOT agency drug and alcohol testing regulations. 49CFR part 40.25 (b)(4) 5. With respect to any employee who violated completion of DOT return-to-duty requirements (including follow-up tests). 49CFR party 40.25 (b)(5) Failure to provide written consent, including former employer(s) information and signature, will result in you being disqualified for a safety sensitive position with MITS, as per 49CFR Part 40.25(a).List ALL previous DOT regulated employer(s) from the last two (2) years:*Company NameAddressCityStateZip Click the "plus" sign to add additional employers Military ServiceBranchFrom MM slash DD slash YYYY To MM slash DD slash YYYY Rank at DischargeType of DischargeIf other than honorable, explain.Additional Information Special SkillsWhich of these skills do you have experience with? Computer Word Processing Software Spreadsheet Software Customer Service Dispatching Transcribing Minutes Accounting Management / Supervisory More InformationFor each skill checked above, please list the number of years of experience you have with that skill and a word or two describing the type of skill. For example:Spreadsheet Software: 5 years - Excel Maintenance SkillsWhich of these skills do you have experience with? Med/Heavy duty diesal diag/repair Tire Repair Auto Elec Systems Multiplex Elec Systems Hybrid Fuel Vehicles Auto Brakes Airbrakes Auto AC Body & Paint Preventative Maintenance More InformationFor each skill checked above, please list the number of years of experience you have with that skill and a word or two describing the type of skill. For example:Hybrid Fuel Vehicles: 5 years - ElectricDo you hold a current valid refrigerant recovery and recycling certification? Yes No Type III?* Yes No Universal?* Yes No Do you hold a current valid fork lift operators license? Yes No Additional InformationDo you have any relatives currently employed at MITS?*Relatives include a spouse, parent, natural/adopted/legal guarded child, brother, sister, niece, nephew, aunt, uncle, daughter-in-law, son-in-law, grandparent, grandchildren, domestic partner, or step-relationship. Yes No If yes, who is/are your relative(s) working at MITS?*As part of MITS' hiring process, we will check your driving history and criminal background. Please provide your driver's license number and date of birth.Do you have a Valid Drivers License?* Yes No Valid Driver's License Number*Date of Birth* MM slash DD slash YYYY During the past two years, have you ever had an alcohol test result of .04 or higher alcohol concentration.* Yes No During the past two years, have you ever had a verified positive drug test?* Yes No During the past two years, have you ever refused to be tested, or adulterated or substituted drug test results?* Yes No During the past two years, have you ever had any other violations of DOT agency drug and alcohol testing regulations?* Yes No If you have ever violated a D.O.T. drug and alcohol regulation, have you successfully completed the D.O.T. return-to-duty requirements, including follow-up-tests?* Yes No Not Applicable DisclaimerI hereby authorize Muncie Indiana Transit System (MITS) and/or the agency contracted by MITS to procure complete information concerning my motor vehicle record from any federal or state agency, insurance carrier, or other organization that may have such.* Yes No As part of the application process, a 30 minute test will be administered. Testing dates are listed on each job posting.* I Agree to Attend the Testing I Cannot Attend the Testing I certify that my answers are true and complete to the best of my knowledge. I acknowledge that any offer of employment is conditional upon successful completion of both drug screening test and a physical examination as parts of MITS' pre-employment policy. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.* I have read and agree to the statement above. Δ
