Date Stamp
An Affirmative Action/Equal Opportunity Employer That Values Diversity
BUS OPERATOR APPLICATION
We are an affirmative action/equal opportunity employer, dedicated to a policy of nondiscrimination in all terms
and conditions of employment. It is the policy of H.N.S. Management Company, Inc. d/b/a CTTRANSIT to
consider all job applications on the basis of merit without regard to race, color, creed, national origin, ancestry,
religion, sex, age, disability or any other legally protected class status. We are a drug and alcohol free workplace.
Read the following before completing application:
1. This application is ONLY for Bus Operators.
2. Applicants MUST complete Application and Inserts.
3. Application may be rejected if answers are vague or application is incomplete.
4. If selected for a position, potential employees must pass an extensive background check, pre-employment
physical (including work assessment) and a drug test for controlled substances prior to starting employment.
Date of Application_________
GENERAL INFORMATION
____________________________________________________________________________________
Last Name
First
Middle
___________________________________________________________________________________________
Street Address
City
State
Zip
________________________
Home Number
________________________
Cell Phone Number
Are you 21 years of age or older? ___Yes ___No
_____________________________________
E-mail address
Have you ever worked for CTTRANSIT? ____Yes ____No
Have you ever been interviewed at CTTRANSIT? ___Yes ___No For what position? ______________________
Which Division are you interested in applying? ______Hartford
_____New Haven
_____Stamford
We only offer full-time positions. List days/hours you are NOT available: _________________________________
_____________________________ Are you available for overtime? ___Yes ___No
Split shifts ___Yes ___No
Can you work nights? ___Yes ___No
Weekends? ___Yes ___No
Holidays? ___Yes ___No
State names of relatives/friends employed by CTTRANSIT: ____________________________________________
Are you either a U.S. Citizen or legally eligible for employment in this country? ___Yes ___No
(Proof of citizenship or immigration status is required upon employment within three (3) days of starting work)
Consistent attendance and punctuality are essential requirements of every job within CTTRANSIT. Is there
anything that would interfere with your regular attendance and punctuality if you were offered a job with the
company? ___Yes ___No
If Yes, please explain__________________________________________________________________________
EDUCATION AND QUALIFICATIONS
EDUCATION
High School and/or
GED
Technical/Trade
School
College
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Name of School and Address
Did you
Graduate?
Have you tested positive for drugs/alcohol or refused to take a pre-employment drug/alcohol test in the three years
preceding the date of this application? Yes____ No____ If Yes, can you provide documents showing successful
completion of the return-to-duty process in accordance with DOT regulations? Yes____ No____
As a prospective employer, we must ask any applicant for a driving position within our company whether they have tested
positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the applicant
applied for, but did not obtain, “safety-sensitive transportation work” during the past three years.
WORK RELATED DRIVING EXPERIENCE (not personal vehicle)
ACCIDENT REVIEW FOR PAST 3 YEARS (Attach additional sheet if more space is needed)
NATURE OF ACCIDENT (Head-on, rear
DATE
end, upset, etc.)
FATALITIES INJURIES
LAST ACCIDENT
NEXT PREVIOUS
NEXT PREVIOUS
List the things you do or steps you take to be a safe driver: ____________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
List any special courses, training or safe driving awards that you have received.
___________________________________________________________________________________________
___________________________________________________________________________________________
Describe briefly any transportation or other experience that may help in your work for CTTRANSIT.
___________________________________________________________________________________________
___________________________________________________________________________________________
CUSTOMER SERVICE EXPERIENCE
Have you ever had a job working with customers? ___Yes ___No If Yes, what services were you expected to
provide? Tell us specifically what you did to guarantee customer satisfaction.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
What did you like most about working with customers? ________________________________________________
___________________________________________________________________________________________
What did you like least about working with customers? ________________________________________________
___________________________________________________________________________________________
What do you think CTTRANSIT passengers will expect from a Bus Operator? ______________________________
___________________________________________________________________________________________
What are the qualities you would bring to CTTRANSIT and our customers?
___________________________________________________________________________________________
___________________________________________________________________________________________
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EMPLOYMENT HISTORY
Please list your employment history for the last ten (10) years. Begin with your present or most recent employment. This section must be
completed. (Resumes can be included but do not mark “see resume”). Attach additional sheets if necessary. You must explain any period
between jobs.
Name of Present or Last Employer
Name of Supervisor:
Address:
Phone Number:
Job Title:
Employment Dates:
From (month/year)
Describe Job Duties:
Salary/Hourly Rate:
Start
To (month/year)
End
Reason for Leaving?
May we contact this employer?
Name of Present or Last Employer
Name of Supervisor:
Address:
Phone Number:
Job Title:
Employment Dates:
From (month/year)
Describe Job Duties:
Salary/Hourly Rate:
Start
Name of Present or Last Employer
Name of Supervisor:
Address:
Phone Number:
Job Title:
Employment Dates:
From (month/year)
Name of Present or Last Employer
Name of Supervisor:
Address:
Phone Number:
Job Title:
Employment Dates:
From (month/year)
Name of Present or Last Employer
Name of Supervisor:
Address:
Phone Number:
Job Title:
Employment Dates:
From (month/year)
Reason for Leaving?
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or
No
Please circle one.
Yes
or
No
Yes
or
No
Yes
or
No
End
May we contact this employer?
Salary/Hourly Rate:
Start
Yes
To (month/year)
Reason for Leaving?
Describe Job Duties:
Please circle one.
End
May we contact this employer?
Salary/Hourly Rate:
Start
No
To (month/year)
Reason for Leaving?
Describe Job Duties:
or
End
May we contact this employer?
Salary/Hourly Rate:
Start
Yes
To (month/year)
Reason for Leaving?
Describe Job Duties:
Please circle one.
Please circle one.
To (month/year)
End
May we contact this employer?
Please circle one.
Have you ever been discharged, dismissed or requested to resign from any job? _____Yes _____No If Yes,
please explain the circumstances: _______________________________________________________________
___________________________________________________________________________________________
REMEMBER TO FULLY COMPLETE APPLICATION AND INSERTS BEFORE RETURNING
I hereby certify that the answers given by me in this application packet are true and correct and
without consequential omissions of any kind. I understand and agree that a false statement or
omission constitutes sufficient cause for the withdrawal of any employment offer or my dismissal
from employment resulting from the application. This application will be kept current for six (6)
months. To be re-considered after this date, I must complete a new application. I understand if I
am a person with a disability, I will request any needed reasonable accommodation to participate in
the application process or interview process. This request must be made in writing to the Human
Resources Officer within 30 days after the need is known. __________ (initial that you have read)
It is further understood that unilateral statements of policy which appear or may appear from time to
time in employee handbooks, manuals, or other Company documents are not contracts and shall
not be construed to modify in any way the explicit provisions of the above statement. I understand
that, if I am employed, I will be required to abide by all rules, regulations, and policies of
CTTRANSIT/H.N.S. Management Company, Inc. It is further understood that no person, other
than the General Manager in writing, has any authority to enter into any employment contract for a
specified period of time or to otherwise enter into any employment contract on behalf of
CTTRANSIT/H.N.S. Management Company, Inc. __________ (initial that you have read)
I understand and agree that employees in training when first hired are subject to discharge at the
Company’s sole discretion. All new employees shall be required to serve a minimum probationary
period of ninety (90) working days from the date the employees’ name is placed on the seniority
list. A probationary employee is subject to discharge at the Company’s sole discretion and such
action shall not be subject to the grievance or arbitration procedure. After such time, the duration
of my employment is dependent upon continued satisfactory conduct and performance of work as
well as upon the Company’s need for my services. CTTRANSIT may terminate my employment in
accordance with the provisions of the applicable labor agreement. If hired, I understand that I am
required to pay union dues whether or not I become a union member of the local chapter of the
Amalgamated Transit Union (ATU). __________ (initial that you have read)
All offers of hire are conditional based on the results of one or more of the following (but not limited
to): post job offer physical examination/work assessment exam, criminal background checks,
satisfactory completion of motor vehicle clearance, references, drug testing, administrative
background checks, etc. I have read the above information and understand the disclaimer. I have
also read the application addendum and consent to release information. I declare, under penalty
of perjury, that all information completed now and during my employment, if hired, is
correct. __________ (initial that you have read)
Can you perform the essential duties of the job for which you are applying with or without a reasonable
accommodation? _____Yes _____No
Applicant’s Signature:
___
Date: _________________
THIS IS AN EMPLOYMENT APPLICATION AND NOT AN EMPLOYMENT CONTRACT
Applications are active for up to six months
9/11
APPLICANT’S NAME: _________________________________________________________________
PRINT NAME
Please review the following section taken from “Connecticut Motor Vehicle Laws” Title 14.
SECTION I - SECTION 14-44J (D-9) TITLE 14
(d) Any person who applies for employment as a driver of a commercial motor vehicle shall provide his prospective
employer, at the time of application, with the following information for the ten years preceding the date of
application;
(1)
(2)
(3)
A list of names and addresses of the applicant’s previous employers for which the applicant was a
driver of a commercial motor vehicle;
The dates between which the applicant drove for each employer; and
The reason for leaving that employer. The applicant must certify that all information furnished is true
and complete. An employer may require an applicant to provide additional information.
(e) Each employer shall require the applicant to provide the information specified in subsection (d) of this section.
(f) No employer shall knowingly allow, permit or authorize a driver to drive a commercial motor vehicle during any
period (1) in which the driver has had their driver’s license suspended, revoked or canceled by any other state, or
has been subject to an out-of-service order, or (2) in which the driver has more than one driver’s license.
(g) Any person who violates any provision of this section shall be deemed to have committed an infraction, and, for
any subsequent offense, shall be fined not more than five hundred dollars.
SECTION II - COMMERCIAL DRIVERS LICENSE (C.D.L.)
A.) Do you currently hold a VALID C.D.L.? YES ____
NO ____
If “YES”, please complete the following:
Operator Number:
Expiration Date:
Class:
Endorsement (s):
Restriction (s):
State of issue:
B.) If you have a CT CDL, how may years have you held this license? _________________
Do you currently hold a valid Medical Examiners Certificate /Certificate of Qualification?
YES ____
NO ____
If “YES”, please complete the following:
Expiration Date:
Issued by (Name of Carrier):
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SECTION III – LICENSE INFORMATION:
State
License Number/Type
Years Held
Expiration Date
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? _____Yes _____No
B. Has any license, permit or privilege ever been suspended or revoked? _____Yes _____No
C. Have you ever been disqualified subject to section 391 of the Federal Motor Carrier Safety Regulation?
_____Yes _____No
D. Have you in the past two (2) years failed or refused a DOT-mandated employment test(s)? _____Yes _____No
If Yes, to any of the above, attach statement giving details.
SECTION IV – DRIVING HISTORY
Please complete this section regarding any arrest(s) or warning(s) for (10) years preceding the date of your
employment application with CTTRANSIT.
Remember you must include ALL violations (other than parking violations) in the United States of America or any
province of Canada relating to motor vehicle traffic control.
LOCATION
DATE
CHARGE
I certify that answers given herein are true and complete to the best of my knowledge.
_______________________________
Signature of Applicant
9/11
________________
Date
PENALTY
APPLICATION ADDENDUM
Have you ever been convicted of a felony crime or misdemeanor? ___Yes ___No
If Yes, please list the date and place of the offense, the charge, circumstances and the
disposition. (A conviction will not necessarily automatically disqualify you for employment. Such factors such as
age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered. Use
additional sheet if necessary).
Date of Conviction
Place
Charge
Fine/Sentence
Criminal History Notice: You are hereby notified that:
1) You are not required to disclose the existence of any arrest, criminal charge or
conviction, the records of which have been erased pursuant to section 46b-146, 54760 or 54-142a;
2) The criminal records subject to erasure pursuant to section 46b-146, 54-760 or 54142a are records pertaining to a finding of delinquency or that a child was a member
of a family with service needs, an adjudication as a youthful offender, a criminal
charge that has been dismissed or nolled, a criminal charge for which the person has
been found not guilty or a conviction for which the person received an absolute
pardon, and
3) That any person whose criminal records have been erased pursuant to section 46b146, 54-760 or 54-142a shall be deemed to have never been arrested within the
meaning of the general statutes with respect to the proceedings so erased and may so
swear under oath.
I have read the above information and understand the disclaimer.
Print Name: __________________________________________
Applicant Signature: _____________________________________________________
Date: ___________________________
CTTRANSIT is an Equal Opportunity Employer, dedicated to a policy of nondiscrimination in employment or application on any basis including
race, color, national origin, ancestry, religion, sex, age, marital status, veteran status, sexual orientation, present or past history of mental
disorder, mental retardation, learning disability or physical disability including but not limited to blindness or any other protected class. We also
comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria.
9/11
AUTHORIZATION RELEASE
As a condition of employment, I hereby authorize H.N.S. Management Company, Inc. d/b/a CTTRANSIT or
its representative to investigate my background to determine suitability for employment and continued
employment if I am hired. In addition, I hereby authorize CTTRANSIT or its representative to investigate my
criminal background and credit history for any positions involving the production of checks, financial
responsibility or the handling of cash or tokens. I understand that all investigative procedures and
conduct will conform to the requirements of Public Law 91-508 (The Fair Credit Reporting Act) and
applicable state and federal statutes.
I authorize representatives from CTTRANSIT to obtain pertinent information from my previous employers,
references, educational institutions and other persons with knowledge of my work history and background.
I authorize my previous employers, references, and other persons with knowledge of my work history,
character and background to provide information to CTTRANSIT and also to release all such persons from
liability and waive any and all claims, demands or causes of action whatsoever, in connection with the
request for a release of such information.
I hereby authorize and request the applicable state agencies and/or a consumer reporting agency to
conduct a search of police records concerning my convictions and/or driving records/ history and to
release them from any and all liability for damage of whatsoever nature whether caused by negligence or
otherwise, on account of furnishing the information above requested. (Information regarding criminal
history will be available to the personnel department and to those individuals with a right to know). I
understand I am not required to disclose the existence of any arrest, criminal charge or conviction, the
records of which have been erased pursuant to section 46b-146, 54-76(o) or 54-142(a), which are records
pertaining to a finding of youthful delinquency or that a child was a member of a family with service needs,
an adjudication as a youthful offender, a criminal charge that has been dismissed or nolled, a criminal
charge for which I have been found not guilty or a conviction for which I have received an absolute pardon.
If my only criminal record consists of items that have been erased under the statutes listed above, then I
may state that I have not been convicted.
I understand that my CTTRANSIT intends to utilize the investigation into my background for employment
purposes only and shall not disclose such information to any other party except as required by law. I
acknowledge receipt of the notice called “A Summary of Your Rights Under the Fair Credit Reporting Act
(FCRA) and certify that I have read and understand that document and this authorization release. I hereby
authorize the obtaining of “consumer reports” and/or “investigative consumer reports” at any time after
signing this authorization and, if I am hired, any time throughout my employment.
I agree that a facsimile (“fax”), electronic or photographic copy of this authorization be accepted with the
same authority as the original. I hereby certify that the answers given by me in this application or other
authorized paperwork are correct and without consequential omissions of any kind. I understand and
agree that a false statement, misrepresentation or omission constitutes sufficient cause for the withdrawal
of any employment offer or my dismissal from any employment resulting from the application and other
forms completed by me. I fully understand the terms of this release.
_______________________________
Print Name
_______________________________
Signature
9/11
_________________
Date
EQUAL EMPLOYMENT OPPORTUNITY/AFFIRMATIVE ACTION VOLUNTARY
INFORMATION
CTTRANSIT is an Equal Opportunity Employer, dedicated to a policy of nondiscrimination in employment
on any basis including race, color, creed, national origin, ancestry, religion, sex, age, disability or any
other legally protected class status. We also comply with all applicable laws governing employment
practices and do not discriminate on the basis of any unlawful criteria
In order to meet State and Federal reporting requirements, we are requesting that you voluntarily supply the
following information. This information will be used and kept confidential in accordance with applicable laws and
regulations. It will not be used for interview purposes and will be kept separate from the Application Form. Your
cooperation in completing this form is appreciated as will enable us to evaluate our recruitment process in
accordance with Affirmative Action policies. Thank you.
Position Applying for: ______________________________________________
Date: ___________________
What source prompted you to apply? (Web, Name of Newspaper, Department of Labor). Please specify:
___________________________________________________
Check appropriate boxes:
Sex:
Male
Female
Are you disabled as per the definition*?
*
Yes
No
One having a verifiable physical or mental impairment which substantially limits one or
more major life activities, or has a record of such impairment, or is regarded as having
such impairment as defined by Americans with Disabilities Act (ADA).
Race/Ethnic Group (The Federal Government uses the following definitions of race/ethnic groups):
American Indian/Alaskan Native -- A person with origins in any of the original peoples of North America who maintains cultural
identification through tribal affiliation or has community recognition as an American Indian or Alaskan Native.
Asian -- A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent. This area
includes, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
Black/African American -- An individual, not of Hispanic origin, with origins in any of the Black racial groups of Africa.
Hispanic/Latino or of Spanish Origin -- A person of Mexican, Puerto Rican, Cuban, Central or South American, or other
Spanish culture or origin regardless of race.
Native Hawaiian or Other Pacific Islander -- A person having origins in any of the original peoples of Hawaii, Guam, Samoa,
or other Pacific Islands.
White -- An individual, not of Hispanic origin, with origins in any of the original peoples of Europe, North Africa, or the Middle East.
__________________________________________________________
Name
______________________________
Phone Number
___________________________________________________________________________________________
Address
City/State/Zip
__________________________________
Date of Birth
9/11