employment application · resume. 2. application must be completed by applicant. please print all...
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EMPLOYMENT APPLICATION
1. Each section of this application must be completed in full, even if accompanied by a resume.
2. Application must be completed by applicant. Please print all responses clearly and accurately.
3. Submitting a resume along with this application is strongly recommended.
4. Individuals applying for a driving position must provide a Massachusetts RMV “Unattested Driving Record” obtained within the last 60 days.
5. Please provide valid phone number and an alternate contact method (E-mail or Phone number).
Veterans Transportation is an Equal Opportunity/Affirmative Action Employer
COMPANY APPLYING FOR: ________________________________________Employment Application
APPLICANT INFORMATION
Last Name First M.I. DateStreet
AddressApartment/Unit #
City State ZIPPhon
eE-mail AddressDate
AvailableDesired Salary
Position Applied forHave you ever worked for this company
YES NO If yes when Why did you leave
Can you work all days, including weekends
YES NO Can you work all
NO
Are you at least 18 years of age?
YES NO Have you ever worked
YES NO
Do you have a valid Drivers License? YES NO License Number State Issued
Do you have a Taxi License YES NO Date Issued Expiration Date
Do you have a 7D license YES NO Date Issued Expiration Date
EDUCATION
High School Address
From To Did you graduate?
YES NO
Degree
CollegeFrom To Did you
graduate?YES NO
Degree
Other
From To Did you graduate?
YES NO
Degree
REFERENCES
Please list three professional references.Full Name Relations
hipCompany Name and address
Phone ( )
Full Name RelationshipCompany Name
and addressPhone ( )
Full Name RelationshipCompany Name
and addressPhone ( )
PREVIOUS EMPLOYMENT
Company
Phone ( )
AddressSupervisor
Job Title
Starting Salary
$Ending Salary
$
Responsibilities
From ToReason for Leaving
May we contact your previous supervisor for a reference?
YES NO
Company
Phone ( )
AddressSupervisor
Job Title
Starting Salary
$Ending Salary
$
Responsibilities
From ToReason for Leaving
May we contact your previous supervisor for a reference?
YES NO
Company
Phone ( )
AddressSupervisor
Job Title
Starting Salary
$Ending Salary
$
Responsibilities
From ToReason for Leaving
May we contact your previous supervisor for a reference?
YES NO
MILITARY SERVICE
BranchFrom
To
Rank at Discharge
Type of Discharge
If other than honorable, explain
DISCLAIMER AND SIGNATURE
I certify 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
Date
REQUEST FOR EMPLOYEE INFORMATION
I am currently being considered for employment at_____________________________________
And hereby authorize any of my former employers to release information about my work history in response to the questions below. I release all former employers of any liability to me for doing so.
_____________________________ _____________________________
Name (please print) Date
_____________________________ _________-_________-_________
Signature Social Security Number
_____________________________________________________________________________________
(For Former Employer Use Only)
Date of Employment: From: _______________ To:_______________
Job Title: ___________________________ Duties:________________________________________
Overall Performance: Excellent_____ Good_____ Fair_____ Poor_____
Attendance: Excellent_____ Good_____ Fair_____ Poor_____
Punctuality: Excellent_____ Good_____ Fair_____ Poor_____
Reason for Leaving: ____________________________________________________________________
Eligible for Rehire? Yes_____ No_____
Prepared by: ____________________ ____________________
Name Date
____________________Title
224 Calvary St.
Waltham, MA 02453
781-647-5211 (Fax) 781-891-7804
www.veteranstransportation.com
Drug and Alcohol Testing
Permission Form
I have been made aware that to be considered for employment; I must submit to and pass a pre-employment drug screen.
In case of an accident where you are deemed to be at fault, the company will require you to take an alcohol and drug test immediately.
In case of an accident where you were not deemed to be at fault, the company reserves the right to have you take an alcohol and drug test immediately.
I have received, read and understood the policy surrounding the alcohol and drugs in the workplace, and give my permission for the company to perform drug and alcohol testing according to this policy.
I UNDERSTAND THAT ANY VIOLATION OF THESE POLICIES AND PROCEDURES WILL SUBJECT ME TO POSSIBLE TERMINATION/SUSPENSION OF DUTIES.
Signature: _________________________ Date:_________________________
Name (please print):_________________________
Applicant/Employee Voluntary Self-identification Form
Veteran's transportation Services believes that all persons are entitled to equal employment opportunities and does not discriminate against its applicants or employees because of race, sex, religious creed, national origin, ancestry, sexual orientation, genetic information, disability, veteran status, age, or any other protected group status. Veteran's Transportation Services is subject to certain governmental recordkeeping and reporting requirements for the administration of civil right laws and regulations.
To comply with these laws and regulations, Veteran's Transportation Services invites you to voluntarily self-identify your sex, race, and ethnicity. Submission of this information is strictly voluntary, and refusal to provide it will not subject you to any adverse treatment. The information provided on this form will be kept confidential and
will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal civil rights enforcement. When reported, this data will not identify any specific individual.
Name____________________________________________________ _ Date_______________
(Please print) Last First Middle
Address______________________________________________________________________________
Number and Street
_____________________________________________________________________________________
City, County, State and Zip Code
Signature__________________________________________________ Date_______________
(Please circle one)
Sex: MALE FEMALE
Race & Ethnicity Categories (Please check only one category):
A.______ American Indian or Alaskan Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
B.______ Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, or Vietnam.
C.______ Black or African-American (Not Hispanic or Latino): A person having origins in any of the Black racial groups of Africa.
D.______ Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
E.______ Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
F.______ White (Not Hispanic or Latino): A person having origins in any of the original people of Europe, the Middle East, or North Africa.
G.______ two or more races: All persons who identify with more than one of the above categories.
_______ (check) I am voluntarily self-identifying as a Veteran.
_______ (check) I am voluntarily self-identifying as a Vietnam Veteran.
_______ (check) I am voluntarily self-identifying as a Disabled Veteran.
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