Application for Employment

Captial Area Transit System (CATS) is an Equal Empolyment Opportuntiy employer. CATS does not discriminate against any applicant or employee on the basis of race, color, sex, religion, national origin, age, disability, or any other consideration made unlawful by applicable federal, state or local laws.

As a matter of policy and for the safety of the communities we serve, CATS consistently applies drug screen and background checking standards to all applicants. It is essential that ALL information requested, including education background, work, criminal and residential history, be complete and accurate.

Instructions: Answer all questions, select all boxes that apply. Answer with "NO" or "NOT APPLICABLE (N/A)" on questions that do not apply. Additional forms are available for each section if needed. Omissions may result in an application being rejected. False, erroneous, or misleading answers or statements may be cause for rejection of application or discharge from CATS. Resumes cannot be substituted in place of this application.

Position Applied For (Separate applications are required for each position for which application is filed)

General Information

Last Name

First Name

Middle Name

Address

City

State

Zipcode

Home Phone Number

Cell Phone Number

Email Address

Employment Information

All employment for the past 10 years must be noted below, included jobs held while in school or while in the military. Record your present or most recent position first and go back in chronological order. Resumes may not be substituted for any information requested, but may be submitted as an addendum to the completed application. Please complete all questions for each position.

Employer Name

Date Employed From

Date Employed To

Salary / Pay Rate (If your compensation changed during employment, please include a range (ex: begin $10 - ending $12))

Employer Address

Employer Phone Number

Supervisors Name and Title

Position(s) held

Briefly explain your job duties and responsibilities including supervisory experience

May we contact this employer?

Yes

Reason for leaving

Employer Name #2

Date Employed From

Date Employed To

Salary / Pay Rate (If your compensation changed during employment, please include a range (ex: begin $10 - ending $12))

Employer Address

Employer Phone Number

Supervisors Name and Title

Position(s) held

Briefly explain your job duties and responsibilities including supervisory experience

Reason for leaving

May we contact this employer

Yes

Employer Name #3

Date Employed From

Date Employed To

Salary / Pay Rate (If compensation changed during employment, please include a range (ex: begin $10 - ending $12))

Employer Address

Employer Phone Number

Supervisors Name and Title

Position(s) held

Briefly explain your job duties and responsibilities including supervisory experience

May we contact this employer?

Yes

Reason for leaving

Employer Name #4

Date Employed From

Date Employed To

Salary / Pay Rate (If compensation changed during employment, please include a range (ex: begin $10 - ending $12))

Employer Address

Employer Phone Number

Supervisor's name and title

Position(s) held

Briefly explain your job duties and responsibilities including supervisory experience

May we contact this employer

Yes

Reason for leaving

Please identify and explain any employment gaps, or periods of unemployment of 30 days or longer. If this section is not applicable, please enter "N/A"

From

Reason

Applicant's Statement and Release

I certify that all statements made on this Application for Employment and in any subsequently executed questionnaire or employment documents are true and correct. I understand that any material falsifications or omissions made on this application, or on any pre-employment document, may result in termination of my candidacy or any subsequent employment.

If an employee relationship is established, I understand that such employment is terminable at will at any time, for any reason, with or without cause, and with or without notice. I also understand that any period of employment is not for any specific duration. In addition, I understand that no one is authorized to make oral exceptiosn to this policy, and written exceptions are permitted only where they are signed by the CEO of Capital Area Transit System (the Company) or his or or designee.

I authorize the Comapny and its representatives to conduct background evaluations and obtain information including but not limited to, criminal history checks from federal, state or local authorities, the Deportment of Transportation (DOT) and/or the Federal Transportation Administration (FTA).

I hereby expressly authorize such inquiries and fully release and discharge the Company and consumer reporting agency, their respective affiliates, subsidiaries, directors, officers, employees, agents and attorneys thereof, and each of them, and any individual organization, entity, agency, or other source providing information to a consumer reporting agency from all claims and damages arising out of or relation to any invesitgation of my background for employment purposes. This release is valid for all federal, state, county and local agencies, authoritis, previous employers, military service and educational institutions.

I acknowledge that any offer of employment is conditioned upon my taking a drug screen and the Company's recipet of satisfactory results of such a test and reciept of satisfactory background checks and, if necessary to determine ability to perform essential duties of the position offered, the satisfactory results of physical examination.

Electronic Signature

Checking this box indicates my signature and acceptance of my statement and release

Today's Date

This Application for Employment will be considered active for 90 calendar days.

The Equal Employment Opportunity Commission (EEOC) requires organizations with 100 or more employees to invite applications to self-identify, gender and race and complete an EEO-1 report each year. Completion of this data is voluntary and will not affect your opportunity for employment, or terms or conditions of employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by the Human Resources department.

Applicants will be invited to self-identify upon completion of the Application for Employment.