Chatham Transit Network

Chatham Transit Network > Application for Employment

Application for Employment

APPLICATION FOR EMPLOYMENT

(This application form is designed to protect individual rights and privacy and to insure equal employment. All questions are considered important for
employment and no other use is intended for the information you submit)

Step 1 of 3

Position applied for*
Name*
Street Address
Street Address City State / Province / Region ZIP / Postal Code Country
Date
MM slash DD slash YYYY
Social Security No.
Phone
Alternate phone number
Name, address and phone number of person to notify in case of emergency
Driver's License Number
Endorsement
May inquiry be made of your present employer regarding your character, qualifications, etc?
- Yes
- No
Please explain
Have you ever been convicted of a felony charge?

EDUCATION
Name of School
Highest year completed
HIGH SCHOOL
Location
Ending Date
MM slash DD slash YYYY
EDUCATION BEYOND HIGH SCHOOL
College or University
Number of years attended
Location
Degree
Year
OTHER EDUCATION
Name
Location
Date
MM slash DD slash YYYY
Degree
List fields of work for which you are licensed, registered or certified, giving dates and sources of issuance.
Describe your experience in computer software, other machines you can operate and other skills in which you are proficient.

PAID EMPLOYMENT RECORD
Last position
Starting Salary
Ending Salary
Name of employer
Supervisor's Name
Address
Telephone
Dates employed
MM slash DD slash YYYY
Date separated
MM slash DD slash YYYY
Reason for leaving
Duties
Last position
Starting Salary
Ending Salary
Name of employer
Supervisor's Name
Address
Telephone
Dates employed
MM slash DD slash YYYY
Date separated
MM slash DD slash YYYY
Reason for leaving
Duties
Please complete an Employment Continuation Sheet if you have additional paid or unpaid work experience.
REFERENCES: In listing references, list persons who are not related to you who have knowledge of your qualifications for the position for which you are applying, such as former co-workers, teachers, etc. Do not repeat names of supervisors you will list under Employment Records above.
Name
Address
Phone
Name
Address
Phone
Name
Address
Phone

Certification of Applicant I certify that to the best of my knowledge and belief, the statements given truly represent my background and experience. In addition, I give the following Authorization to Release Information: I hereby authorize my previous employers, personal references listed and other persons or institutions shown on my application for employment to provide any information requested.

Application for Employment

Application for Employment

CHATHAM TRANSIT NETWORK

APPLICATION FOR EMPLOYMENT

Step 1 of 3

EDUCATION

HIGH SCHOOL

EDUCATION BEYOND HIGH SCHOOL

OTHER EDUCATION

PAID EMPLOYMENT RECORD

Please complete an Employment Continuation Sheet if you have additional paid or unpaid work experience.