Pee Dee Regional Transportation Authority: Be Transported - Online Forms Archive

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Applying For:

* Job Title:

* Location:

How Do We Contact You:

* Name:

* Email:

* Mailing Address Street:

* City:

* State:

* Zip Code:

* Home Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Work Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Other Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Your Education:

High School

* High School Name:

* High School Address:

* Diploma:

If You Selected Other, Please Describe:

* Highest Grade Completed:

College

* College Graduate?:

Your Name, If Different, While Attending:

Undergraduate School:

Degree Earned:

Year Degree Obtained from Undergraduate School:

Graduate School:

Degree Earned:

Year Degree Obtained from Graduate School:

Training / Skills

* List Any Skills, Licenses, or Certificates Related to the Job Applied For:

Work Experience:

Present or Last Employer

Name of Present or Last Employer:

Address of Present or Last Employer:

Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Job Title:

Supervisor's Name:

Supervisor's Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Employed From:

Employed To:

Hours per Week:

Salary:

May We Contact This Employer?:

Job Duties:

Reason For Leaving:

Next Most Recent Employer 1

Name of Next Most Recent Employer:

Address:

Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Job Title:

Supervisor's Name:

Supervisor's Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Employed From:

Employed To:

Hours per Week:

Salary:

May We Contact This Employer?:

Job Duties:

Reason For Leaving:

Next Most Recent Employer 2

Name of Next Most Recent Employer:

Address:

Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Job Title:

Supervisor's Name:

Supervisor's Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Employed From:

Employed To:

Hours per Week:

Salary:

May We Contact This Employer?:

Job Duties:

Reason For Leaving:

Next Most Recent Employer 3

Name of Next Most Recent Employer:

Address:

Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Job Title:

Supervisor's Name:

Supervisor's Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Employed From:

Employed To:

Hours per Week:

Salary:

May We Contact This Employer?:

Job Duties:

Reason For Leaving:

Next Most Recent Employer 4

Name of Next Most Recent Employer:

Address:

Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Job Title:

Supervisor's Name:

Supervisor's Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Employed From:

Employed To:

Hours per Week:

Salary:

May We Contact This Employer?:

Job Duties:

Reason For Leaving:

Work Experience:

Do You Have Any Relatives Employed With PDRTA?

Name of Relative:

Relation:

Name of Relative:

Relation:

Criminal Offenses

Have You Ever Been Convicted of a Criminal Offense?:

Note: Omit any offense committed before your 17th birthday which was finally adjudicated in juvenile court or under a youthful offender law. Conviction of a criminal offense is not a bar to employment in all cases. Each conviction is evaluated individually.

If Yes, Please List Charge(s):

Where Convicted:

Date of Conviction:

Disposition / Status:

Employment Termination

Have You Ever Been Terminated or Forced to Resign From Any Job?:

If Yes, Please Explain:

Are You Legally Authorized to Work in the United States?:

References

Name:

Address:

Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Name:

Address:

Phone (ie: XXXXXXXXXX - no spaces, hyphens or slashes):

Driver Information

Do You Possess a Valid Driver's License?:

How Many Years Driving?:

Do You Have a CDL?:

If So, What Class?:

What Endorsements?:

CDL License Number:

How Long Have You Had Your CDL?:

How Many Motor Vehicle Accidents Have You Ever Been Involved In, Regardless of Severity?:

How Many Motor Vehicle Accidents As An Operator Of A Commercial Vehicle?:

How Many Motor Vehicle Accidents As An Operator Of A Private Vehicle?:

Last Accident Date:

Last Accident City and State:

Last Accident Explanation:

Next Previous Accident Date:

Next Previous Accident City and State:

Next Previous Accident Explanation:

During the Past Two (2) Years. If You Were Subject to DOT Testing Requirements

Have You Had An Alcohol Test With A Result Of 0.04 Or Higher Alcohol Concentration?:

Have You Had A Verified Positive DOT Drug Test?:

Have You Refused To Be Tested (Including Verified Adulterated or Substituted Drug Test Results)?:

Have You Committed Other Violations of DOT Agency Drug And Alcohol Testing Regulations?:

If Answering "Yes" To Any Of The Above, Have You Successfully Completed DOT Return-To-Duty Requirements, Including Follow-Up Tests?:

Equal Employment Opportunity Data (All Questions Below Are Fully Optional):

Government contractors are subject to federal laws such as the Vietnam Era Veterans Readjustment Assistance Act of 1974, the Americans with Disabilities Act, and other requirements including having an Affirmative Action Plan. In order to fulfill these requirements, please provide the information requested below. Refusal to answer will not result in adverse treatment of any applicant. This information is not used in the employment process nor released in a manner which identifies the individual.

Last Name:

First Name:

Middle Name:

Position For Which You Are Applying:

Sex:

Date of Birth:

Race:

Veteran:

Disabled Veteran:

Vietnam Era Veteran:

Will You Need Reasonable Accommodation To Participate In The Selection Process?:

If Yes, Please State Type:

PDRTA Actively Supports The Family Independence Act By Hiring Welfare And Food Stamp Recipients For Certain Jobs. Are You Currently Receiving AFDC Benefits Or Food Stamps?:

How Did You Hear About Employment With PDRTA?:

If Other, Please Explain:

Form Security

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Please Carefully Read The Following Statements

Authority to Release Information: By my electronic signature (click of the submit button), I consent to the release of information to authorized officers, agents, and/or emplyees of the Pee Dee Regional Transportation Authority which may include but not be limited to information concerning my past and present work, including my official personnel files; attendance records; evaluations; educational records; military service; law enforcements records; motor vehicle records; and/or any personnel record deemed necessary. In addition, I consent to authorize appropriate officers, agents, and/or employees of the Pee Dee Regional Transportation Authority to make inquiries of third parties such as credit bureaus. I further release the organization, educational entity, present and former employers, law enforcement organization, and all third parties from any and all claims of whatever nature that I may have as result of any inquiry or response given to such inquiries made in connection with my application for employment.

Certification of Applicant: By my electronic signature (click of the submit button), I affirm, agree and understand that all statements on this form are ture and accurate. Any misrepresentation, falsification, or material omission of information or data on this application may result in exclusion from further consideration or, if hired, termination of employment. If I have requested herein that my present employer not be contacted, an offer of employment may be conditioned upon acceptable information and verification from such employer prior to beginning work. I also affirm, agree and understand that any offer of employment is conditional upon receipt of a negative DOT drug test to be performed at a time and place directed by Pee Dee Regional Transportation Authority.

CAREER OPPORTUNITY APPLICATION

Applying For:

How Do We Contact You:

Your Education:

High School

College

Training / Skills

Work Experience:

Present or Last Employer

Next Most Recent Employer 1

Next Most Recent Employer 2

Next Most Recent Employer 3

Next Most Recent Employer 4

Work Experience:

Do You Have Any Relatives Employed With PDRTA?

Criminal Offenses

Employment Termination

References

Driver Information

During the Past Two (2) Years. If You Were Subject to DOT Testing Requirements

Equal Employment Opportunity Data (All Questions Below Are Fully Optional):

Form Security

Please Carefully Read The Following Statements

Career Opportunity Application

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