Job Applications

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Section 1: Personal Information

First Name

Last Name

Street Address Line 1

Street Address Line 2

City

State/Province

Zip/Postal

Phone Number

Email

Are you 18 years or older? * (required) Yes No

Are you eligible to work in the U.S.? * (required) Yes No

Emergency Contact Full Name

Emergency Contact Phone Number

Emergency Contact Address

Have you ever plead “no contest” to or been convicted of theft, shoplifting, robbery, embezzlement, forgery, perjury, tax evasion, or any other crime involving dishonesty? (required) Yes No

Are you currently under indictment, arraignment, or charged with a felony? * (required) Yes No

Section 2: Employment Desired

Position(s) you are applying for: If applying for multiple roles, separate roles with commas

Date Available To Start

Desired Salary

Type of work sought: (required) Full-Time Part-Time Seasonal Internship

Referred By

Section 3: Education

Please complete, even if attaching a resume.

Highschool

Years Completed

Did you graduate? (required) Yes No

Major/Degree

College

Years Completed

Did you graduate? (required) Yes No

Major/Degree

Trade, Business or Other School

Years Completed

Did You Graduate? Yes No

List any computer software you are proficient with (i.e. Word, Excel, Access, PowerPoint, BSA, GIS):

List any special skills, licenses, certifications, or knowledge applicable to the position you are seeking:

Activities (Civic, Athletic, Etc) - Exclude organizations, the name of which indicates the race, creed, sex age, marital status, genetic information, color or nation of origin of its members.

Section 4: Driving History

Do you currently hold a Michigan Drivers' License? (required) Yes No

Michigan Drivers' License Number

Michigan Drivers' License Expiration Date

Do you currently hold a Commercial Drivers' License? Yes No

Commercial Drivers' License Expiration Date

Does your driving record contain any of the following: more than 2 points, more than 2 moving violations in the past 3 years, more than 1 at-fault accident, speeding 15 mph over limit or more, reckless/careless driving, open intoxicants, and/or a drug crime? Yes No

Have you ever tested positive for drugs or alcohol on a DOT required test? (required) Yes No

Do you have reliable transportation to get to work? (required) Yes No

Section 5: Employment and Experience - Please complete, even if attaching a resume.

Former Employers (List below last four employers, starting with most recent):

US Military service dates:

Rank:

Present membership in National Guard or Reserves? Yes No

Employer 1:

Date Started:

Date Left:

Starting Pay:

Ending Pay:

Job Title(s):

Your job responsibilities:

Supervisor:

Department:

Employer 1 Address:

City

State/Province

Zip/Postal

Country

Are you presently employed? Yes No

If yes, may we contact? Yes No

Reason for Leaving:

Employer 2:

Date Started:

Date Left:

Starting Pay:

Ending Pay:

Job Title(s):

Your job responsibilities:

Supervisor:

Department:

Employer 2 Address:

City

State/Province

Zip/Postal

Country

Are you presently employed? Yes No

If yes, may we contact? Yes No

Reason for Leaving:

Employer 3:

Date Started:

Date Left:

Starting Pay:

Ending Pay:

Job Title(s):

Your job responsibilities:

Supervisor:

Department:

Employer 3 Address:

City

State/Province

Zip/Postal

Country

Are you presently employed? Yes No

If yes, may we contact? Yes No

Reason for Leaving:

Employer 4:

Date Started:

Date Left:

Starting Pay:

Ending Pay:

Job Title(s):

Your job responsibilities:

Supervisor:

Department:

Employer 4 Address:

City

State/Province

Zip/Postal

Country

Are you presently employed? Yes No

If yes, may we contact? Yes No

Reason for Leaving:

Have you ever been fired, dismissed, asked to resign, resigned by mutual agreement, or otherwise been terminated from any job? Yes No

May Harbor Transit contact these employers? Yes No

Which of these jobs did you like best?

What did you like most about this job?

Section 6: References

Give names of three work related references, not related to you, whom you have known at least one (1) year. Please complete all information.

Reference Name

Address

Phone #

Relationship

Years Acquainted

Reference Name

Address

Phone #

Relationship

Years Acquainted

Reference Name

Address

Phone #

Relationship

Years Acquainted

Section 7: Voluntary Disclosure Form

Harbor Transit provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, national origin, sex (including gender identity, sexual orientation, and pregnancy), age, genetic information, disability, veteran status, or other protected class. This applies to all personnel actions, including but not limited to recruitment, hiring, selection for training, promotion, transfer, demotion, layoff, termination, rates of pay, or other forms of compensation. Completion of this form is entirely voluntary and will not affect your employment status, application, or opportunities with Harbor Transit. The information will be kept confidential and used only in accordance with the provisions of applicable federal laws, executive orders, and regulations, including those requiring information to be summarized and reported to the federal government for civil rights purposes. All race/ethnicity information is collected and reported in six EEO-4 categories established by the federal government: (A) Asian; (B) Black or African American; (H) Hispanic or Latino; (I) American Indian or Alaska Native; (P) Native Hawaiian or Other Pacific Islander; or (W) White. If you choose not to disclose your race/ethnicity, the federal government requires the employer to determine this information by visual survey and/or other available information. Please mark one box describing the gender identity, race/ethnicity, and veteran status with which you identify.

Gender Identity: Please select the gender you identify with most. Female Male Prefer Not To Say

Race/Ethnicity: Please check all that apply. Asian Black or African American Hispanic or Latino American Indian or Alaska Native Native Hawaiian or Other Pacific Islander White Two or More Races Prefer not to answer

Veteran Status: Are you a United States military veteran? I am a veteran I am not a veteran Prefer not to answer

Personal Information (Used only for data tracking purposes.) Optional

First Name

Last Name

Date

Section 8: Voluntary Self-Identification of a Disability

Form CC-305 OMB Control Number 1250-0005 WHY ARE YOU BEING ASKED TO COMPLETE THIS FORM? Federal law requires us to provide equal employment opportunity to qualified people with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years. Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

Disabilities include, but are not limited to: Alcohol or other substance use disorder (not currently using drugs illegally) Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS Blind or low vision Cancer (past or present) Cardiovascular or heart disease Celiac disease Cerebral palsy Deaf or serious difficulty hearing Diabetes Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders Epilepsy or other seizure disorder Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome Intellectual or developmental disability Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD Missing limbs or partially missing limbs Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS) Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities Partial or complete paralysis (any cause) Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema Short stature (dwarfism) Traumatic brain injury

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability.

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. To request a reasonable accommodation, please contact the Human Resources Director at (616) 842-3220, ext. 4, or hr@harbortransit.org

Disability Status Yes, I have a disability, or have had one in the past No, I do not have a disability and have not had one in the past Prefer not to answer

Personal Information (Used only for data tracking purposes.) Optional

First Name

Last Name

Date

Section 9: Authorization and Waiver

As part of my employment application filed with Harbor Transit, I have listed my former and/or current employers, as well as additional references. I authorize each former or current employer and each additional reference to communicate directly with Harbor Transit relative to my employment record and any other relevant information which would or could have a bearing on my ability or inability to adequately perform for Harbor Transit the job for which I have applied. I specifically waive any right I have under Section 6 of Michigan Public Act 397 of 1978, as now or subsequently amended (the “Bullard-Plawecki Employee Right to Know Act), to receive written notice if a current or former employer divulges a disciplinary report, letter of reprimand, or other disciplinary action to Harbor Transit. I release all former employers, education institutions, law enforcement agencies, and credit reporting services from, and I waive any liability or claim relating to the release of information or opinions, and any employment decisions made by Harbor Transit as a result thereof. I understand and agree that Harbor Transit may conduct a criminal conviction record check (including but not limited to a driving conviction record check) in connection with my application for employment. By signing below I hereby consent to such record checks and authorize the release of such records. I 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, my application may also be rejected and, if I am employed, my employment may be terminated. In consideration of my employment, I agree to conform to Harbor Transit’s policies and procedures. I certify that I have read and understand the provisions of this application. My questions concerning the application, if any, have been asked and answered to my satisfaction. For purposes of this authorization and waiver, a photocopy of my signature shall have the same force and effect as my original signature.

Name (Please print)

Date