Beaver County Transit Authority (BCTA) is an Equal Opportunity Employer. We adhere to the laws and to the principles of fair employment practices in all of our terms and conditions of employment for employees and qualified applicants. We do not discriminate on the basis of age, race, sex, color, national origin, religion, disability, veteran status. We do not allow harassment of any type, including sexual harassment. This application will be given consideration for appropriate available positions as long as the applicant is qualified to perform the essential duties of the open position. Our receipt of the application does not in any way imply that the applicant will be employed. We are an at will employer. Please complete the application fully and honestly. No action will be taken on applications that are incomplete and we will not consider applicants for any position if the information is not accurate and honest. We will terminate the employment of anyone who is employed if we subsequently find the application information was inaccurate or dishonest. Personal InformationName* First Middle Last Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Social Security Number*Are you at least 18 years old?*YesNoHave you ever been convicted of a felony?*YesNoFelony Convictions*ReasonDateStatus Are you a citizen or do you have the legal right to be employed in the United States?*YesNoIf no, what is your visa?*VisaStatusHave you applied to BCTA before?*YesNoPrior applications to BCTA*DatePosition Position You Are Applying For*When are you available to start?* Date Format: MM slash DD slash YYYY Type of employment applying for*Full TimePart TimeSpecific ShiftNo PreferenceDo you currently have a CDL License?*YesNoAre you applying for Bus Operator or other driving position requiring the use of BCTA vehicles?*YesNoAll licenses you are currently in possession of including CDL if applicable*License TypeLicense NumberDate IssuedExpiration Date Do you have a resume you would like to submit?*YesNoSubmit your resume*If you have submitted a file, please review the form and fill in any fields that may not be on your resume.Education and Training BackgroundPlease start with elementary school to most recent education and include any trade or vocational school training.Elementary School*School NameLocation City & StateYear StartedYear Ended High School or GED?*High SchoolGEDHigh School*School NameLocation City & StateYear StartedYear EndedDiploma, Degree, Certificate AwardedMajor and Minor Subjects GED*StateYear EarnedVocational, Technical or CollegeSchool NameLocation City & StateYear StartedYear EndedDiploma, Degree, Certificate AwardedMajor and Minor Subjects Employment BackgroundWill this be your first job?*YesNoAre you currently employed?*YesNoCurrent or Most Recent Employer*Company NameCity & StateEmployment Dates*StartEndWage or Salary*StartingEndingTitles Held - Please begin with most recent* Duties*Supervisor's Name*May we contact your supervisor*YesNoSupervisor's Phone*Reason for leaving (please be specific)*Prior EmployerCompany NameCity & StateEmployment DatesStartEndWage or SalaryStartingEndingTitles Held - Please begin with most recent DutiesSupervisor's NameMay we contact your supervisorYesNoSupervisor's Phone*Reason for leaving (please be specific)Prior EmployerCompany NameCity & StateEmployment DatesStartEndWage or SalaryStartingEndingTitles Held - Please begin with most recent DutiesSupervisor's NameMay we contact your supervisorYesNoSupervisor's Phone*Reason for leaving (please be specific)Military BackgroundAre you currently or have you ever been enlisted in the military?YesNoBranch of ServiceDates of ServiceStartingEndingSkills, training and positions Volunteer BackgroundVolunteer experience or activities. Do not give any information that could reveal protected class status (age, race, sex, religion, national origin, disability, veteran) ,unless you believe the information strongly supports your qualifications and you give it voluntarily. We do not discriminate based on protected class status. Volunteer activity is often a good complement to work history. Please also give any leadership roles.Volunteer ExperienceVolunteer OrganizationDuties ReferencesPlease list 3 references we may check who are not related to you.Reference 1*NameCity, StatePhoneRelationshipYears Known Reference 2*NameCity, StatePhoneRelationshipYears Known Reference 3*NameCity, StatePhoneRelationshipYears Known Driving Experience and Equipment ExperienceOnly fill out Driving Experience if applying for driver position.Equipment ExperienceClass of EquipmentType of EquipmentDate RangeApprox. Miles (Total) Have you ever had any accidents while driving a motor vehicle?*YesNoAccident Record - Begin with most recent and include past 3 years*DateNature of AccidentFatalitiesInjuries Have you had any traffic convictions or forfeitures (other than parking violations)?YesNoTraffic Convictions and Forfeitures (other than parking violations) - Begin with most recent and include past 3 years*LocationDateChargePenalty Have you ever been denied a license, permit or privilege to operate a motor vehicle?YesNoHas any license, permit or privilege ever been suspended or revoked?*YesNoEqual Opportunity Employment - Voluntary Self IdentificationWe are an Equal Opportunity Employer. As an equal opportunity employer, we strive to have a workforce that reflects the community we serve. No person is lawfully excluded from employment opportunities based on race color, religion, national origin, sex(including gender identity, sexual orientation, and pregnancy), age, genetic information, disability, veteran status or other protected class. The purpose of this Employee EEO Self-Identification Form is to comply with federal government record-keeping and reporting requirements. Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records. If you choose not to self-identify your race/ethnicity at this time, the federal government requires Beaver County transit Authority to determine this information by visual survey and/or other available information. Name* First Last Job Applying For*Date* Date Format: MM slash DD slash YYYY Do you wish to self identify?* Yes No Gender* Male Female I do not wish to disclose Race / Ethnicity* Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East or North Africa. Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa. Native Hawaiian or Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands. Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. Native American or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above six races. I do not wish to disclose. Are you a Veteran?*YesNoI do not wish to disclose.Date of Discharge* Date Format: MM slash DD slash YYYY Protected Veterans (Please select all that apply)* Active duty wartime or campaign badge Veteran - a veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. Armed Forces Service Medal Veteran - any veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 FR 1209, 3 CFR, 1996 Comp., p. 159). Disabled Veteran - (1) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or (2) a person who was discharged or released from active duty because of a service-connected disability. Recently Separated Veteran - a veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval or air service. I am a protected veteran, but I choose not to self-identify the classifications to which I belong. I am NOT a protected veteran. If you are a disabled veteran, it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability. The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed. AccomodationsVoluntary Self-Identification of DisabilityWhy are you being asked to complete this form? Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Blindness Deafness Cancer Diabetes Epilepsy Autism Cerebral palsy HIV/AIDS Schizophrenia Muscular dystrophy Bipolar disorder Major depression Multiple sclerosis (MS) Missing limbs or partially missing limbs Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair Intellectual disability (previously called mental retardation) Please check one of the boxes below.* Yes, I have a disability (or previously had a disability) No, I do not have a disability I do not wish to answer Reasonable Accommodation Notice Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete. Date* Date Format: MM slash DD slash YYYY Signature*Please read the following information before you sign, date and submit this Application. Your signature attests that you have read and understood the information and that you agree to what is stated. The information in this Application is true and complete to the best of my knowledge. Falsification of information is reason to not hire an individual and reason for immediate termination of any employee. Any offer of employment by BCTA may be withdrawn and any acceptance by myself may be withdrawn. I understand that BCTA is an at-will employer. All offers of employment are conditional until successful passage of a drug and alcohol screen and any other job-related required pre-employment testing or verification. Driver’s licenses and CDL licenses will be verified for driving positions. I authorize BCTA to verify any and all information contained in this Application without any legal liability. BCTA abides by privacy regulations but has a definite need-to-know for this information. Essential duties of some positions require being on call, being available to work different shifts, being able to work weekends, overtime or split shifts, certain capabilities (i.e. visual acuity for bus operators, communication and language abilities for bus operators and dispatch or related positions, physical capability to operate buses and other company vehicles and similar capabilities), etc Where physical or mental limitations exist in applicants, BCTA recognizes the need to discuss reasonable accommodations for otherwise qualified applicants. We are a public employer operating to serve the public and we have a position of trust with the public. We also strive to be a best practices employer for our staff. We seek and employ candidates who meet our needs and standards. I have read and understood these statements and have completed the Application fully and honestly. NameThis field is for validation purposes and should be left unchanged.