CIT Employment Form

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APPLICATION FOR EMPLOYMENT

(Answer ALL questions – please print)

In compliance with Federal, State, and Local equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, gender, sexual orientation, national origin, age, marital status, or non-job related disability.

Date of Application:

Position(s) Applied for:

Name*

First Name

Middle Name

Last Name

Social Security Number:

List your addresses for last three (3) years:

Current Address:

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

How Long?

Prior Address 1:

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

How Long?

Prior Address 2:

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

How Long?

Do you have the legal right to work in the United States?

Date of Birth (REQUIRED FOR COMMERCIAL DRIVERS)

Can you provide proof of age?

Have you worked for this company before?

Dates: From

Rate of Pay:

Position:

Reason for Leaving:

Are you currently employed?

If not, how long since last employment?

Who referred you?

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the attached job description)?

Yes No

If yes, please explain

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following employment information during the preceding three (3) years. Please list complete mailing address, city, state, and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional seven (7) years’ (10 total) information on prior employers for whom the applicant operated such a vehicle.

Please list employers beginning with the most recent. Add another sheet as necessary.

EMPLOYER

Position(s) Applied for:

Name*

First Name

Middle Name

Last Name

Address:

Address Line 1

Address Line 2

City

State

ZIP Code

Contact:

Phone*

DATE

From

POSITION

SALARY/WAGE

REASON FOR LEAVING

Was job Safety sensitive subject to alcohol/controlled substance testing under 49 CFR part 40?

Were you subject to Federal Motor Carrier Safety Regulations while performing your job?

EMPLOYMENT HISTORY

Please list employers beginning with the most recent. Add another sheet as necessary.

EMPLOYER

Position(s) Applied for:

Name*

First Name

Middle Name

Last Name

Address:

Address Line 1

Address Line 2

City

State

ZIP Code

Contact:

Phone*

DATE

From

POSITION

SALARY/WAGE

REASON FOR LEAVING

Was job Safety sensitive subject to alcohol/controlled substance testing under 49 CFR part 40?

Were you subject to Federal Motor Carrier Safety Regulations while performing your job?

EMPLOYMENT HISTORY

Please list employers beginning with the most recent. Add another sheet as necessary.

EMPLOYER

Position(s) Applied for:

Name*

First Name

Middle Name

Last Name

Address:

Address Line 1

Address Line 2

City

State

ZIP Code

Contact:

Phone*

DATE

From

POSITION

SALARY/WAGE

REASON FOR LEAVING

Was job Safety sensitive subject to alcohol/controlled substance testing under 49 CFR part 40?

Were you subject to Federal Motor Carrier Safety Regulations while performing your job?

EMPLOYMENT HISTORY

Please list employers beginning with the most recent. Add another sheet as necessary.

EMPLOYER

Position(s) Applied for:

Name*

First Name

Middle Name

Last Name

Address:

Address Line 1

Address Line 2

City

State

ZIP Code

Contact:

Phone*

DATE

From

POSITION

SALARY/WAGE

REASON FOR LEAVING

Was job Safety sensitive subject to alcohol/controlled substance testing under 49 CFR part 40?

Were you subject to Federal Motor Carrier Safety Regulations while performing your job?

EMPLOYMENT HISTORY

Please list employers beginning with the most recent. Add another sheet as necessary.

EMPLOYER

Position(s) Applied for:

Name*

First Name

Middle Name

Last Name

Address:

Address Line 1

Address Line 2

City

State

ZIP Code

Contact:

Phone*

DATE

From

POSITION

SALARY/WAGE

REASON FOR LEAVING

Was job Safety sensitive subject to alcohol/controlled substance testing under 49 CFR part 40?

Were you subject to Federal Motor Carrier Safety Regulations while performing your job?

EMPLOYMENT HISTORY

Please list employers beginning with the most recent. Add another sheet as necessary.

EMPLOYER

Position(s) Applied for:

Name*

First Name

Middle Name

Last Name

Address:

Address Line 1

Address Line 2

City

State

ZIP Code

Contact:

Phone*

DATE

From

POSITION

SALARY/WAGE

REASON FOR LEAVING

Was job Safety sensitive subject to alcohol/controlled substance testing under 49 CFR part 40?

Were you subject to Federal Motor Carrier Safety Regulations while performing your job?

*Includes vehicles having a GVWR of 26,001 lbs or more, vehicles designed to transport 15 or more passengers, orany size vehicle used to transport hazardous materials in a quantity requiring placarding.

EDUCATION

Circle highest grade completed: High School: - Copy

8 9 10 11 12

College

1 2 3 4

Grad School:

Last school attended: (Name) (City)

EXPIRATION DATE:

EXPERIENCE AND QUALIFICATION - DRIVER

DRIVER LICENSES: STATE:

LICENSE NO:

TYPE:

EXPIRATION DATE:

DRIVER LICENSES: STATE:

LICENSE NO:

TYPE:

EXPIRATION DATE:

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

Yes No

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

Yes No

IF THE ANSWER TO EITHER IS YES, ATTACH STATEMENT GIVING DETAILS.

Please list accidents for the past 3 years (attach another sheet if more space needed). If none, write NONE.

DATE

NATURE OF ACCIDENT

FATALITIES

INJURIES

DATE

NATURE OF ACCIDENT

FATALITIES

INJURIES

Please list all traffic convictions and forfeitures (other than parking violations) for the past 3 years. If none, write NONE:

DATE

LOCATION

CHARGE

PENALTY

DATE

LOCATION

CHARGE

PENALTY

DRIVING EXPERIENCE (IF NONE, WRITE NONE):

CLASS OF EQUIPMENT: TYPE:

FROM

APPROX # OF MILES

List states operated in within last five years:

Which safe driver awards to you hold and from whom?

Any special courses or training that will help you as a bus/coach driver?

Please list any transportation or other experience that may help you in your work for CIT:

List any other courses or training other than shown elsewhere on this application:

List special equipment or technical materials you can work with other than any already listed:

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

I authorize CIT to make such investigations and inquiries of my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. (Inquiries of medical history will be made if an offer of employment has been extended.) I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interviews may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

Date

Applicant’s Signature

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