EASTERN UPPER PENINSULA TRANSPORTATION AUTHORITY (E.U.P.T.A.) APPLICATION FOR EMPLOYMENT (PRE-EMPLOYMENT QUESTIONNAIRE) (AN EQUAL OPPORTUNITY EMPLOYER)
PERSONAL INFORMATION DATE Click or tap to enter a date.
NAME
LAST FIRST MIDDLE PRESENT ADDRESS
STREET CITY STATE ZIP CODE PERMANENT ADDRESS
STREET CITY STATE ZIP CODE PHONE NO. ARE YOU 18 YEARS OR OLDER? Y ☐N☐
ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF IMMIGRATION STATUS? Y ☐N☒
EMPLOYMENT DESIRED
POSITION DATE YOU CAN START SALARY DESIRED Click or tap to enter a date.
ARE YOU EMPLOYED NOW? Y ☐N☐ IF SO, MAY WE INQUIRE OF YOUR PAST AND PRESENT EMPLOYERS? Y ☐N☐
EVER APPLIED TO THIS COMPANY BEFORE? Y ☐N☐ WHERE? WHEN?
REFERRED BY
EDUCATION	NAME/ LOCATION	YEARS COMPLETED	DIPLOMA DEGREE	COURSE OF STUDY
HIGH SCHOOL	Y ☐N☐
COLLEGE	Y ☐N☐
VOCATIONAL/TRADE	Y ☐N☐
GENERAL SUBJECTS OF SPECIAL STUDY OR RESEARCH W0RK SPECIAL SKILLS ACTIVITIES: (CIVIC, ATHLETIC, ETC.) EXCLUDE ORGANIZATIONS. THE NAME OF WHICH INDICATES THE RACE, CREED, SEX, AGE, MARITAL STATUS, COLOR, OR NATION OF ORIGIN OF ITS MEMBERS. U.S. MILITARY OR NAVAL SERVICE RANK PRESENT MEMBERSHIP IN NATIONAL GUARD OR RESERVES Y ☐N☐

This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC an July 26. 1991.

WORK EXPERIENCE (List most current or most recent job first).

EMPLOYMENT DATE MONTH AND YEAR	NAME AND PHONE OF EMPLOYER	HOURLY RATE/ SALARY	POSITION	REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO
FROM
TO

WHICH OF THESE JOBS DID YOU LIKE BEST?

WHAT DID YOU LIKE MOST ABOUT THIS JOB?

REFERENCES: GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.

NAME	BUSINESS	PHONE NUMBER	YEARS ACQUAINTED

IN CASE OF EMERGENCY NOTIFY

Name	Phone

"'l CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE. AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN ITS PRESIDENT, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.”

Signature	Click or tap here to enter text.	Click or tap to enter a date.

This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination.

This Application for Employment Form is used for general use throughout the United States.