Job Application : Tulsa Transit

Name*

First

Last
Social Security Number*
Phone*
Current Address - Please list addresses for 3 years*

Street Address

Address Line 2

City

State

ZIP Code
How long at this address
Previous Address 1

Street Address

Address Line 2

City

State

ZIP Code
How long at this address 1
Previous Address 2

Street Address

Address Line 2

City

State

ZIP Code
How long at this address 2
Previous Address 3

Street Address

Address Line 2

City

State

ZIP Code
How long at this address 3
Are you a US Citizen?*
- Yes
- No
If Not a Citizen, What Type of VISA do you now have?*
- Student
- Permanent Entry U.S.A.
- Other: Specify below in the Comments Section
Comments*

Position Applied for*
Date Available
Desired Salary
Type of Work Desired
Will you consider shift work or weekends?
- Yes
- No
Are you related to anyone at Tulsa Transit?*
- Yes
- No
Who are you related to?*

First

Last

High School
Grade Completed*
- 9
- 10
- 11
- 12
Did you attend Business or Vocational school?
- Yes
- No
Business or Vocational School name:
College:
Degree Received/ Major Subject:
Organizations:

Do not list any organizations, clubs, etc. the names of which might indicated race, color, religion, or national origin of its members

Were you in the US military?
- Yes
- No
Military Service Date Entered:

MM slash DD slash YYYY

Attach DD-214
Attach DD-214
Max. file size: 100 MB.
Branch
Discharge Date

MM slash DD slash YYYY
Type of Work Performed

Have you previously worked for this company?*
- Yes
- No
Dates employed
Reason for leaving
How were you referred?
Employee Name:
Website:
Name:
Station:
Name:
Other:

Have you ever been convicted of a felony?*
- Yes
- No
Explain*
Other information which will assist in your employment (IE: Foreign languages, special skills, etc)

Beginning with last (or present) Employment, List Work of Last 3 years (Last 10 years if applying for Driving Positions)
From:*
To:
*

Company Name and Phone Number: Supervisor Name: May we contact? Duties Salary Reason for Leaving
A Safety Sensitive Position?*
- Yes
- No
Subject to Federal Motor Carrier Safety Regulations?*
- Yes
- No
From:
To:
Company Name and Phone Number: Supervisor Name: May we contact? Duties Salary Reason for Leaving
A Safety Sensitive Position?
- Yes
- No
Subject to Federal Motor Carrier Safety Regulations?
- Yes
- No
From:
To:
Company Name and Phone Number: Supervisor Name: May we contact? Duties Salary Reason for Leaving
A Safety Sensitive Position?
- Yes
- No
Subject to Federal Motor Carrier Safety Regulations?
- Yes
- No
Provide Job History for 10 Years
- Add More Job History
From:
To:
Supervisor Name: May we contact? Duties Salary Reason for Leaving
A Safety Sensitive Position?
- Yes
- No
Subject to Federal Motor Carrier Safety Regulations?
- Yes
- No
From:
To:
Company Name and Phone Number: Supervisor Name: May we contact? Duties Salary Reason for Leaving
A Safety Sensitive Position?
- Yes
- No
Subject to Federal Motor Carrier Safety Regulations?
- Yes
- No
From:
To:
Company Name and Phone Number: Supervisor Name: May we contact? Duties Salary Reason for Leaving
A Safety Sensitive Position?
- Yes
- No
Subject to Federal Motor Carrier Safety Regulations?
- Yes
- No
Provide Job History for 10 Years (2)
- Add More Job History
From:
To:
Company Name and Phone Number: Supervisor Name: May we contact? Duties Salary Reason for Leaving
A Safety Sensitive Position?
- Yes
- No
Subject to Federal Motor Carrier Safety Regulations?
- Yes
- No
From:
To:
Company Name and Phone Number: Supervisor Name: May we contact? Duties Salary Reason for Leaving
A Safety Sensitive Position?
- Yes
- No
Subject to Federal Motor Carrier Safety Regulations?
- Yes
- No
From:
To:
Company Name and Phone Number: Supervisor Name: May we contact? Duties Salary Reason for Leaving
A Safety Sensitive Position?
- Yes
- No
Subject to Federal Motor Carrier Safety Regulations?
- Yes
- No
From:
To:
Company Name and Phone Number: Supervisor Name: May we contact? Duties Salary Reason for Leaving
A Safety Sensitive Position?
- Yes
- No
Subject to Federal Motor Carrier Safety Regulations?
- Yes
- No

Are you applying to be a driver or will you be using a company vehicle?*
- Yes
- No
Drivers License Number:
Expiration Date:

MM slash DD slash YYYY
Issued by which state?
Type of License?
- C.D.L.
- Operator
- Passenger Endorsement
Have you ever been denied a license, permit or privledge to operate a motor vehicle?*
- Yes
- No
Has any license, permit, or privledge ever been suspended, denied or revoked?*
- Yes
- No
You answered yes to having an issue with a permit, license, or privledge. Please write a statement giving details.*

Straight Truck over 26,000 GVW
Dates:
Approx. Number of Miles (Total)
Tractor/Trailer
Dates:
Approx. Number of Miles (Total)
BUS
Dates:
Approx. Number of Miles (Total)
List states operated in during last 10 years:
Special courses or training taken:
Safe driving awards held:

Have you had any traffic violations or convictions (Other than parking) in the past three years?*
- Yes
- No
Have you had any convictions or forfeitures involving possession, sale, manufacturing, transportation or use of drugs?*
- Yes
- No
List your convictions:

City, State Date Charge Penalty
List your convictions:

City, State Date Charge Penalty
List your convictions:

City, State Date Charge Penalty
I understand that the information on this application will be used and that prior employers will be contact for the purpose of investigation. This is required by CFR Part 383.35 of the federal motor carrier safety regulations.

References (List 3):

Name Address and Phone Number Years Known

List personal references - not relatives or former employers
Name Address and Phone Number Years Known
Name Address and Phone Number Years Known
Upload Resume Here:
Accepted file types: pdf, doc, docx, Max. file size: 8 MB.

Statement of Certification and Authority for Release of Information

1. I hereby submit my electronic application for employment and authorize the release of all information relating to my background from current employers, former employers, criminal justice agencies, financial or lending institutions, or individuals to any representative of Tulsa Transit to consider my application for employment.

This information may include, but is not limited to: salary, work experience, education, personal history relating to achievements, performance, attendance, or disciplinary actions involving me, any criminal record relating to me (including arrests and convictions), and any credit information.

I further release any individual, including records custodians, from all liability for damages that may result to me as a result of compliance or any attempts to comply with this authorization.

2. I certify that the statements in this application are correct and complete to the best of my knowledge. I also understand that any misrepresentation or deliberate omission of a material fact in my application may be justification for denial, or if employed, termination from Tulsa Transit employment.
3. Tulsa Transit reserves the right to rescind any offer of employment.

4. I understand that after a conditional job offer is made, I must successfully complete and pass a D.O.T. physical exam and drug screen administered by Tulsa Transit’s physicians.

5. I understand that this application will be in effect for six months from the date indicated below and if employment is not offered within the six month period, I must reapply to be considered for future employment.

6. I understand that the information on this application will be used and that prior employers will be contacted for the purpose of investigation for employment purposes. This is required by CFR part 383.35 of the Federal Motor Carrier Safety Regulations.

7. I agree to the above statements by entering my name below and submitting this Application for Employment to Tulsa Transit.
Ethinicity-Name*

Name Date
Ethnicity-SSN
Etnicity-Position

Position Applying for:
Ethnic Classification
- Caucasian
- African American
- Asian
- Hispanic/Latino
- American Indian/Alaskan Native
- Native Hawaiian/Pacific Islander
Sex:
- Male
- Female
Metropolitan Tulsa Transit Authority is an Equal Opportunity Employer

Job Application

Step 1 of 13

Statement of Certification and Authority for Release of Information

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