PLEASE READ CAREFULLY

This is a confidential employment application. Please answer all questions as completely and accurately as possible. Failure to complete this form thoroughly may result in disqualification of your application. If a question does not apply, put N/A (not applicable) in place of an answer.

If you are applying for a position that requires you to submit a current, original H6 DMV printout (see job announcement for applicability), it must be received in our offices by the position deadline date or within 10 working days of your application submission date, whichever is earlier.

All prospective new hires will be asked to provide proof of their authorization to work in U.S. and to submit an acceptable document that establishes their identity.

Note that fields marked with an * are required.

GENERAL INFORMATION
* Position applied for:
   
* First Name
Middle Name
* Last Name
* Mailing Address
* City
* State
* Zip Code
  Email Address
* Home Phone Please include your area code (i.e. 555-123-4567)
Mobile / Cell Phone Please include your area code (i.e. 555-123-4567)
Message Phone Please include your area code (i.e. 555-123-4567)
* Social Security Number (last 4 digits) (i.e. 6789)
Previous Names (if needed to check work or education record):
* Salary Required:
* Date available for work: (MM/DD/YYYY)
If hired, can you furnish:  
* (a) Proof of age 18 or older? Yes No
* (b) Proof of U.S. citizenship, permanent
residency or authorization to work in the U.S.?
Yes No
* Have you applied to RTA previously? Yes No
If yes, when? (MM/YYYY)
And for what position?
* Have you worked for RTA? Yes No
If yes, when? From: (MM/YYYY) To: (MM/YYYY)
* I am available to work Any Full-time Part-time Regular Temporary
If Temporary, how long?
* Days available to work:

Any Monday Tuesday Wednesday
Thursday Friday Saturday Sunday

* Shift(s) available to work: Any Day Swing Grave
* Available for overtime: Yes No
To prevent close family relationships from adversly affecting job performance, RTA will not employ an immediate family member in a position with responsibility to supervise another immediate family member. Immediate family shall mean father, father-in-law, mother, mother-in-law, brother, brother-in-law, sister, sister-in-law, spouse, son, son-in-law, daughter or daughter-in-law.
* Does RTA currently employ any of your immediate family as defined here? Yes No
If yes, name of employee:
* Have you ever had a job that involved driving? Yes No
If yes, what type of vehicles?
* Do you have a valid California drivers license? Yes No
License Number:
Expiration Date: (MM/DD/YYYY)
Class: Class A Class B Class C
List endorsements, if any:
* Has your drivers license ever been revoked or suspended? Yes No

If yes, please explain:

* How many moving violations have you received in the last four (4) years?
* How many traffic accidents have you been involved in during the last five (5) years?
* Are there any restrictions on your drivers license? Yes No

If yes, please explain:

* Have you ever been convicted of an offense other than a minor traffic violation? Yes No

If yes, please explain below. (Do not include convictions while a minor and/or convictions sealed by Court order.) Convictions are not necessarily disqualifying.

RTA requires prospective new hires to be tested for the use of drugs and/or alcohol and to complete a pre-employment medical examination. Would you consent to this examination and drug screening at RTA’s expense?

Yes No

EDUCATION AND TRAINING
When claiming College, Business or Vocational School credit for meeting minimum qualifications, you may be required to submit a copy of your degree or a legible photocopy of your current transcript with this application. Failure to do so may delay processing or disqualify your application.
* High School Graduate or GED? Yes No
   
Name of Colleges & Universities Attended
Address (City & State)
Major or Courses Taken
Degree/Units
   
Name of Colleges & Universities Attended
Address (City & State)
Major or Courses Taken
Degree/Units
   
Additional Colleges & Universities (in the same format as above.)
   
Name of Business/Trade School(s)
Address (City & State)
Subject
Degree/Units
   
Name of Business/Trade School(s)
Address (City & State)
Subject
Degree/Units
   
Additional Business/Trade School(s) (in the same format as above.)
   
Other Training, Licenses or Certificates
   
Please indicate your skills and equipment knowledge:

AUTOMOTIVE, BUS OR TRUCK SKILLS

 

Brake Reline
Engine Tune-up
Tire Changes, Lubes, Oil Changes
Engine Repair & Overhaul (Gas)
Engine Repair & Overhaul (Diesel)
Electrical Systems

CLERICAL SKILLS

 

Typing wpm
Shorthand wpm
Dictaphone
Adding Machine by touch by sight
Software (state type(s)):
Hardware (state type(s)):
Other skills and equipment knowledge (please describe):
EMPLOYMENT HISTORY
This section must be fully completed, even if you have attached a resume. Account for all employment, beginning with your current or most recent employer and list in reverse chronological order. If additional space is needed, please complete the Additional Employment History field below. Explain any periods of unemployment. If no experience, indicate reason. There should be no period of time longer than one (1) month that is unexplained.
In order to verify employment experience, may we contact your past and current employers? Yes No
 
Name of Company
Title of your starting position
Title of your last position
Phone (i.e. 555-123-4567)
Mo/Yr Hired (MM/YYYY)
Mo/Yr Left (MM/YYYY) Still employed
Starting Salary
Ending Salary
Street Address
City
State
Zip
Your name while there
Name of Supervisor
Supervisor’s Phone (i.e. 555-123-4567)
Reason for leaving
Description of duties of your last position
 
Name of Company
Title of your starting position
Title of your last position
Phone (i.e. 555-123-4567)
Mo/Yr Hired (MM/YYYY)
Mo/Yr Left (MM/YYYY) Still employed
Starting Salary
Ending Salary
Street Address
City
State
Zip
Your name while there
Name of Supervisor
Supervisor’s Phone (i.e. 555-123-4567)
Reason for leaving
Description of duties of your last position
 
Name of Company
Title of your starting position
Title of your last position
Phone (i.e. 555-123-4567)
Mo/Yr Hired (MM/YYYY)
Mo/Yr Left (MM/YYYY) Still employed
Starting Salary
Ending Salary
Street Address
City
State
Zip
Your name while there
Name of Supervisor
Supervisor’s Phone (i.e. 555-123-4567)
Reason for leaving
Description of duties of your last position
 
Name of Company
Title of your starting position
Title of your last position
Phone (i.e. 555-123-4567)
Mo/Yr Hired (MM/YYYY)
Mo/Yr Left (MM/YYYY) Still employed
Starting Salary
Ending Salary
Street Address
City
State
Zip
Your name while there
Name of Supervisor
Supervisor’s Phone (i.e. 555-123-4567)
Reason for leaving
Description of duties of your last position
 
Name of Company
Title of your starting position
Title of your last position
Phone (i.e. 555-123-4567)
Mo/Yr Hired (MM/YYYY)
Mo/Yr Left (MM/YYYY) Still employed
Starting Salary
Ending Salary
Street Address
City
State
Zip
Your name while there
Name of Supervisor
Supervisor’s Phone (i.e. 555-123-4567)
Reason for leaving
Description of duties of your last position
 
Additional Employment History (in the same format as above.)
   

If any periods of time are not covered by the information above, please provide dates and details.

* Have you ever been involuntarily terminated (fired)? Yes No

If yes, please provide employer's name and details:

   

Please provide any additional information important to your application.  This may include a cover letter or resume.  You may copy this information from a Word or similar document and paste here.

   
   

PLEASE READ CAREFULLY BEFORE SUBMITING

By submiting, I certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any of the statements checked by the RTA unless I have indicated to the contrary. I authorize the references listed above, as well as all other individuals whom the RTA contacts, to provide the Agency any and all information concerning my previous employment and any other pertinent information that they may have. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to the RTA as well as from the use or disclosure of such information by the Agency or any of its agents, employees, or representatives. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer or, if I am hired, my dismissal from employment. I also understand that any offer of employment shall be subject to successful completion of a physical examination and drug test.

In consideration of my employment, I agree to conform to the rules and standards of the RTA, as amended by the Agency from time to time at its discretion. I further agree that my employment and compensation can be terminated at will, with or without cause, and with or without notice, at any time, either at my option or at the option of the Agency. I understand that no employee or representative of the RTA, other than the Chief Executive Officer, has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. Further, the Chief Executive Officer of the RTA may not alter the at-will nature of the employment relationship unless he/she does so specifically and in writing that he/she dates and signs.

   
* Your Name:
Today's Date: (MM/DD/YYYY)
   


 
If you would like a copy of this form for your records, please print it now.