Employment Application

Step 1 of 13

Today's Date:(Required)

Month

Day

Year

Position(s) of Interest:(Required)

General Information

Name:(Required)

First Middle Last

Address:(Required)

Street Address Address Line 2 City State ZIP Code

Phone:(Required)

Email:(Required)

When are you available to begin work?(Required)

Are you seeking:(Required)

Full Time

Part Time

Check All That Apply

Desired Wage/Salary:(Required)

Are you available to work any hours, including weekends?(Required)

Yes

Please explain your availablity:(Required)

Are you prevented from becoming lawfully employed in the U.S. due to your visa or immigration status?(Required)

Yes

Have you ever been convicted of a crime that has not been expunged by a court?(Required)

Yes

Please explain which crimes that you have been convicted of:(Required)

Have you ever applied here before?(Required)

Yes

When did you last apply here?(Required)

Have you ever worked here before?(Required)

Yes

When did you work here?(Required)

Do you have any relatives working for Transpo?(Required)

Yes

What are the name(s) of your relatives that work at Transpo?(Required)

Did anyone other than a relative refer you for employment with Transpo?(Required)

Yes

Please provide the name of the person who referred you:(Required)

Have you ever in the course of employment, refused to submit to a drug test or tested positive for any illegal substance?(Required)

Yes

Have you ever been discharged from any employment or asked to resign?(Required)

Yes

Please explain why you were discharged or asked to resign:(Required)

Education

Please Enter Highest Grade Completed:(Required)

High School

College

Graduate School

Technical/Trade

Name & Location of High School:

Name & Location of College:

Name & Location of Graduate School:

UntitledName & Location of Technical/Trade School:

If you did not graduate from high school, do you have a GED?

Yes

Experience & Qualifications

Do you have a valid driver's license?(Required)

Yes

License Number:(Required)

State of Issue:(Required)

Expiration Date:(Required)

Type of License:(Required)

Operators

CDL Class A

CDL Class B

For-Hire Endorsement

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

Yes

Please explain why you have been denied a license, permit, or privilege to operate a motor vehicle:(Required)

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

Yes

Please explain why your license, permit, or privilege ever been suspended or revoked:(Required)

Have you had any special courses or training that will help you as a driver?(Required)

Yes

Please list courses and/or training:(Required)

Please list accident record for the last seven (7) years. Click the "+" button to add more rows. If none, please write none.(Required)

Date of Accident

Nature of Accident

Fatalities

Injuries

Please list traffic convictions and forfeitures for the last seven (7) years. Click the "+" button to add more rows. If none, please write none.(Required)

Date of Conviction/Forfeiture

Location

Charge

Penalty

List specific experience, including length of time, you have in the following areas:

Accounts Payable/Accounts Receivable:

Payroll:

Microsoft Office (Word, Excel, Outlook, Access, PowerPoint):

List specific mechancial experience, including length of time, you have in the following areas:

Engine Tune-Up (Diesel):

Engine Tune-Up (Gasoline):

Electrical Systems:

Transmissions:

Brakes/Steering:

Tire Repair:

List any other experience and/or skills you feel are relevant to the position for which you are applying:

Employment History

All applicants must provide the following information on all employers during the last seven (7) years. Complete mailing address, street number, city, state, zip code, and phone number with area code. List the most recent employers first.

EMPLOYER #1

Company Name:(Required)

Phone:(Required)

Address:(Required)

Street Address Address Line 2 City State ZIP Code

Start Date:(Required)

Month

Day

Year

End Date:(Required)

Month

Day

Year

Last Position Held:(Required)

Starting Salary/Wage:(Required)

Ending Salary/Wage:(Required)

Major Duties/Responsibilities:(Required)

Reason for Leaving:(Required)

May we contact this employer?(Required)

Yes

Contact Person:(Required)

First Last

Title:(Required)

Would you like to add another employer?(Required)

Yes

EMPLOYER #2

Company Name:(Required)

Phone:(Required)

Address:(Required)

Street Address Address Line 2 City State ZIP Code

Start Date:(Required)

Month

Day

Year

End Date:(Required)

Month

Day

Year

Last Position Held:(Required)

Starting Salary/Wage:(Required)

Ending Salary/Wage:(Required)

Major Duties/Responsibilities:(Required)

Reason for Leaving:(Required)

May we contact this employer?(Required)

Yes

Contact Person:(Required)

First Last

Title:(Required)

Would you like to add another employer?(Required)

Yes

EMPLOYER #3

Company Name:(Required)

Phone:(Required)

Address:(Required)

Street Address Address Line 2 City State ZIP Code

Start Date:(Required)

Month

Day

Year

End Date:(Required)

Month

Day

Year

Last Position Held:(Required)

Starting Salary/Wage:(Required)

Ending Salary/Wage:(Required)

Major Duties/Responsibilities:(Required)

Reason for Leaving:(Required)

May we contact this employer?(Required)

Yes

Contact Person:(Required)

First Last

Title:(Required)

Would you like to add another employer?(Required)

Yes

EMPLOYER #4

Company Name:(Required)

Phone:(Required)

Address:(Required)

Street Address Address Line 2 City State ZIP Code

Start Date:(Required)

Month

Day

Year

End Date:(Required)

Month

Day

Year

Last Position Held:(Required)

Starting Salary/Wage:(Required)

Ending Salary/Wage:(Required)

Major Duties/Responsibilities:(Required)

Reason for Leaving:(Required)

May we contact this employer?(Required)

Yes

Contact Person:(Required)

First Last

Title:(Required)

Would you like to add another employer?(Required)

Yes

EMPLOYER #5

Company Name:(Required)

Phone:(Required)

Address:(Required)

Street Address Address Line 2 City State ZIP Code

Start Date:(Required)

Month

Day

Year

End Date:(Required)

Month

Day

Year

Last Position Held:(Required)

Starting Salary/Wage:(Required)

Ending Salary/Wage:(Required)

Major Duties/Responsibilities:(Required)

Reason for Leaving:(Required)

May we contact this employer?(Required)

Yes

Contact Person:(Required)

First Last

Title:(Required)

Please explain any gaps or periods of unemployment:

Pre-Employment Notificatin & Acknowledgement

Drug Test Consent

I understand and agree to the drug test statement.

I understand and acknowledge that I will be required to undergo a urine drug test under the authority of the U.S. Department of Transportation (DOT), Federal Transit Administration (FTA) prior to being hired or transferred into a safety-sensitive position as defined in CFR Part 6551. I understand and acknowledge that I will not be assigned to perform a safety-sensitive function unless my urine drug test has a verified negative result.

Have you tested positive, or refused to test, on any DOT pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, a safety-sensitive position in the past two years?(Required)

Yes

If you answered YES, can you provide documentation that you successfully completed the DOT return-to-duty requirements described in 49 CFR Part 40, Subpart O?(Required)

Yes

Referral Source

Please let us know how you heard about the position that you are applying for today.

Transpo Employee

Walk In

Word of Mouth

Indeed.com

South Bend Tribune

TransitTalent.com

Work One

Michigan Works

TheLadders.com

WNDU

WSBT

Flier/Sign

Radio

Employment Agency

Mass Transit

Transpo Website

Other

Check all that apply.

Please list name of Transpo Employee:

Please share what other source referred you to Transpo:

Voluntary Self-Identification

South Bend Public Transportation Corporation (Transpo) is an equal opportunity / affirmative action employer. As such, we are subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. To comply with these laws, we invite you to voluntarily self-identify your ethnicity/race, disability and veteran status. Self-identification is voluntary and there will be no negative consequences if you elect not to disclose this information. The information obtained will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations. When reported, the data will not identify any specific individual.
Regardless of whether or not you choose to self-identify, completion of this form is mandatory. If you do not wish to self-identify, please check the “decline to disclose” box.

Name:(Required)

First Last

Work Location:

Gender:(Required)

Female

Male

Are you Hispanic or Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or orgin regardless of race)?(Required)

Yes

Decline to Disclose

Race:(Required)

WHITE (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, North Africa, or the Middle East

BLACK or AFRICAN AMERICAN (Not Hispanic or Latino) – A person having origins in any of the Black racial groups of Africa

NATIVE HAWAIIAN or OTHER PACIFIC ISLANDER (Not Hispanic or Latino) – A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands

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, Camboida, China, India, Japan, Korea, Malaysia, Pakistan, the Phillppine Islands, Thailand, and Vietnam

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 recognition

TWO or MORE RACES (Not Hispanic or Latino) – All person who identify with more than one of the above five races

DECLINE TO DISCLOSE

Disability/Veteran Status
If you have a disability or are a veteran as defined below and you would like to be included in our affirmative action program, please tell us now and/or at any time in the future.
Information you submit about your disability will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of individuals with disabilities, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if the condition might require emergency treatment; and (iii) government officials engaged in enforcing the Americans with Disabilities Act or laws administrated by the Office of the Federal Contract Compliance Programs may be informed.
If you are an individual with a disability or a disabled veteran and (a) would like to request an accommodation that would enable you to successfully perform the job for which you have received an offer of employment, or other types of positions within the company; or (b) would prefer to inform the company of this information verbally, please contact the Human Resource Department.

Please check ALL that apply below:(Required)

An individual with a disability is a person who (a) has a physical or mental impairment which substantially limits one or more major life activities, (b) has record of such impairment; or (c) is regarded as having such impairment.

Disabled Veteran means a veteran of the U.S. military, ground, naval, or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans Affairs, or a person who was discharged or released from active duty because of a service-connected disability.

Recently Separated Veteran means a veteran separated during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.

Armed Forces Service Medal Veteran means a veteran who, while serving on active duty in the U.S. military, ground, naval, or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive order 12985 (61 FR 2109)

Other Protected Veteran means a veteran who served on active duty in the U.S. Military, ground, naval, or air service during a war or in a campaign or expedition for which a campaign badge has been authorized under laws administered by the Department of Defense.

None of the above

Decline to disclose

Date of Discharge:(Required)

Month

Day

Year

Applicant's Statement

Applicant's Statement:(Required)

I certify that I have read, understand and agree to the statement below.

I certify that all statements made on this application for employment, and in any subsequently executed medical questionnaire, are true and correct to the best of my knowledge. I understand that if any false information, omissions, or misrepresentations are discovered, the application will be rejected and, if I am employed, will be grounds for discipline up to and including termination of my employment.

I understand that the Fair Credit Report Act, Public Law 91-508, requires that I be advised that routine inquiry may be made during Transpo’s initial or subsequent processing which will provide applicable information concerning character and general reputation. I also understand that upon written request, additional information as to the nature and scope of the inquiry, if one is made, will be provided to me.

I authorize Transpo and its representatives to inquire of all former employers, or others who know me of know of me. It is agreed and understood that Transpo and its agents may conduct background evaluations to ascertain any and all information of concern, whether same is of record or not, and I release all employers and persons named herein from all liability for any damages on account of their furnishing such information.

I authorize Transpo to request and obtain my Motor Vehicle Report for consideration of my application for employment.

I acknowledge that any offer of employment is conditional upon successful completion of a drug screen and DOT physical examination. I further acknowledge that I have not been subjected to and refused to take and/or failed any drug screen or alcohol test during the 24 calendar month period preceding the date listed below.

I understand that should an employment offer be extended to me and accepted that I will full adhere to the policies, rules and regulations of employment with Transpo.

Signature:(Required)

Your Name
Your Name
Your Name

Today's Date:(Required)

Month

Day

Year

Get the Token Transit App

No Cash. No Cards. No Contact. The Token Transit App offers a quick and reliable way to purchase fares. Download the app today!

Quick Trip Planner

Starting Point

Destination

Departure Date (MM/DD/YYYY)

Departure Time (HH:MM)

AM / PM

Employment

Employment Application

Employment Application

General Information

Education

Experience & Qualifications

List specific experience, including length of time, you have in the following areas:

List specific mechancial experience, including length of time, you have in the following areas:

Employment History

Pre-Employment Notificatin & Acknowledgement

Referral Source

Voluntary Self-Identification

Applicant's Statement

Get the Token Transit App

Quick Trip Planner

Phone

Email

Information Line Hours

Transpo Administrative Offices

Office Hours

Transpo Quick Links

Transpo

Rider Alerts 8