PAGE 1 of 8 VTA SANTA CLARA VALLEY TRANSPORTATION AUTHORITY June 18, 2004 Notice to All VTA Applicants: Your application for employment is important to VTA. Therefore it is necessary that, in addition to the information requested on the application, your full response to the items listed here is required. Please contact VTA Employee Services Department (408-321-5575) if you require additional information. Question #11 You must list and explain all felony and misdemeanor convictions since the age of 18. Additional Question: Can you legally work in the United States without VTA sponsorship? Please respond to this question on your application in the section between Question 12 and Question 13. PAGE 2 of 8 VTA SANTA CLARA VALLEY TRANSPORTATION AUTHORITY EMPLOYMENT APPLICATION READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING • Answer all questions. Print in ink or type. Incomplete or illegible applications may be disqualified. • A separate application must be submitted for each position. • Machine copied applications will be accepted with original signatures. • Falsification or deceptive omission of requested information will cause application rejection, removal from eligible lists, or dismissal from employment. • For additional information or questions contact the Personnel Department at (408) 321-5575. • Unless otherwise stated on examination bulletin, return your completed, signed, and dated application to: Valley Transportation Authority Personnel Department 3331 North First Street, Building B San Jose, CA 95134-1906 1. Position (Give exact title of position for which you are applying) [ ] Full-time [ ] Transfer [ ] Part-time [ ] W.O.O.C. 2. Your Last Name First Middle 3. Social Security Number 4. Your Street Address City State Zip 5. Home Phone ( ) Business Phone ( ) 6. Driver’s license number, State, type & expiration date–if required for this position. 7. Have you ever applied for any position with VTA? If so, when and what position? 7a. [ ] Yes [ ] No Any prior name? If so, what? 7b. [ ] Yes [ ] No 8. Have you ever been employed with VTA? If so, please explain. [ ] Yes [ ] No 9. Do you have any relatives working for VTA? If so, please provide name and relationship. [ ] Yes [ ] No 10. Have you received any vehicle citations for moving violations within the last 3 years? [ ] Yes [ ] No 11. Have you ever been convicted by a court for ANY felony or misdemeanor since the age of 18? (Not all convictions are an automatic bar to employment. Each case is considered on its individual merits.) [ ] Yes [ ] No ALL CONVICTIONS, WHETHER FELONY OR MISDEMEANOR MUST BE DISCLOSED. Failure to disclose any conviction shall disqualify an applicant from employment and future employment consideration with VTA. 12. Do you speak any languages other than English? Please list. Any YES answers to items 7a, 7b, 8, 9, 10, or 11 must be FULLY explained here. Attach a separate sheet if necessary. 13. Do you need any accommodation in taking an examination due to a disability? [ ] Yes [ ] No 13a. If yes, please describe the desired accommodation: ________________________________ 14. Have you ever been granted an accommodation for a previous examination at VTA? You must provide the Personnel Department with written verification from a doctor, rehabilitation counselor, or other authorized person confirming your disability and indicating a reasonable accommodation. This space for Personnel use only Application: [ ] Accepted [ ] Rejected Reviewer’s Initials: Date Reviewed: Reason for Rejection: [ ] Experience [ ] Education [ ] Req. Driver's License [ ] DUI [ ] Late Application [ ] Incomplete Application ___________ [ ] Criminal Conviction [ ] Need More Information [ ] Other (specify) ___________________________________________________ Reviewer’s comments: LIST CODE: SEQUENCE: DMV SENT: DMV CLEAR: F.P. DATE: F.P. CLEAR: AN EQUAL OPPORTUNITY EMPLOYER PAGE 3 of 8 15. Education Did you graduate from high school? [ ] Yes [ ] No If you did not graduate from high school, do you have a G.E.D. equivalent? [ ] Yes [ ] No Name and Location of Trade school or College attended: _________________ Major Subject: ___________________ Units Completed: _________________ Degree Received: ________________ Name and Location of Trade school or College attended: _________________ Major Subject: ___________________ Units Completed: _________________ Degree Received: ________________ Name and Location of Trade school or College attended: _________________ Major Subject: ___________________ Units Completed: _________________ Degree Received: ________________ 16. Licenses and Certificates which are applicable to this position: Description: Issued by: Number: 17. Employment History • You must list at least the last ten years of work experience, unless total work history is less than 10 years. • Resumes will not be accepted in place of a completed application. • Complete all questions and respond to all requirements listed in the job bulletin. • Describe different positions held with the same employer in different blocks. • List your most recent experience first & attach additional sheets if necessary. • List relevant volunteer experience. From: Mo./ Yr. To: Mo./ Yr. Employer (Business or Agency Name) Title of Your Present or Previous Position Telephone Number Hours Per Wk. Address City State Zip Name of Supervisor: May we contact this employer? [ ] Yes [ ] No Salary: $ Duties: Reason for Leaving: From: Mo./ Yr. To: Mo./ Yr. Employer (Business or Agency Name) Title of Your Present or Previous Position Telephone Number Hours Per Wk. Address City State Zip Name of Supervisor: May we contact this employer? [ ] Yes [ ] No Salary: $ Duties: Reason for Leaving: From: Mo./ Yr. To: Mo./ Yr. Employer (Business or Agency Name) Title of Your Present or Previous Position Telephone Number Hours Per Wk. Address City State Zip Name of Supervisor: May we contact this employer? [ ] Yes [ ] No Salary: $ Duties: Reason for Leaving: PAGE 4 of 8 From: Mo./ Yr. To: Mo./ Yr. Employer (Business or Agency Name) Title of Your Present or Previous Position Telephone Number Hours Per Wk. Address City State Zip Name of Supervisor: May we contact this employer? [ ] Yes [ ] No Salary: $ Duties: Reason for Leaving: From: Mo./ Yr. To: Mo./ Yr. Employer (Business or Agency Name) Title of Your Present or Previous Position Telephone Number Hours Per Wk. Address City State Zip Name of Supervisor: May we contact this employer? [ ] Yes [ ] No Salary: $ Duties: Reason for Leaving: From: Mo./ Yr. To: Mo./ Yr. Employer (Business or Agency Name) Title of Your Present or Previous Position Telephone Number Hours Per Wk. Address City State Zip Name of Supervisor: May we contact this employer? [ ] Yes [ ] No Salary: $ Duties: Reason for Leaving: From: Mo./ Yr. To: Mo./ Yr. Employer (Business or Agency Name) Title of Your Present or Previous Position Telephone Number Hours Per Wk. Address City State Zip Name of Supervisor: May we contact this employer? [ ] Yes [ ] No Salary: $ Duties: Reason for Leaving: Certification: I certify that all of the statements made on this application are true, complete and correct to the best of my knowledge and belief and are made in good faith. I understand that I will be fingerprinted and investigated prior to appointment. Signature of Applicant (sign in ink) Date Signed PAGE 5 of 8 PERSONNEL DEPARTMENT EMPLOYMENT DISQUALIFICATION DUE TO CRIMINAL CONVICTIONS (This form must be completed) Valley Transportation Authority requires the disqualification of applicants who have been convicted of certain types of criminal misconduct. Information regarding this policy and the types of offenses which disqualify applicants is provided on the job application form. This policy requires all applicants for employment to disclose all criminal convictions on the application form since the age of 18. All applicants for employment will be fingerprinted for the purpose of obtaining “Criminal Conviction” information. Because it is not always possible for the Personnel staff to make a determination as to whether conviction information disclosed on a job application would result in mandatory job disqualification, applicants may be accepted into the examination process (up to and including final interview and job offer) and may be employed pending the results of the fingerprint check. The fact that a conviction has been disclosed on the application and that a candidate has nonetheless been accepted into the examination process does not mean that a determination has been made by the Personnel Department regarding the conviction. Such determination cannot be made until the results of the fingerprint check are received. Because the results of the fingerprint check take several weeks to be received, it is often the case that an offer of employment is made before the results of the fingerprint check have been received. If the results of the fingerprint check disclose a disqualifying offense or a discrepancy between the conviction information provided on the application and the fingerprint check, the employee will be subject to immediate termination. I have read and understood the information regarding the Valley Transportation Authority procedures regarding mandatory disqualification of job applicants. Applicant Name (Print) Applicant Signature Date Signed Position PAGE 6 of 8 FINGERPRINT PROGRAM NOTIFICATION FORM Dear VTA Job Applicant: As a condition of employment, you will be fingerprinted to obtain Criminal Conviction information from California and Federal record agencies. If you have been convicted of a crime involving one or more of the activities listed below, your application for employment may not be considered: A. Convicted upon a charge of a disqualifying public offense listed below: • Operating a motor vehicle while under the influence of alcohol, an amphetamine, a narcotic drug, formulations of anamphetamine, or a derivative of a narcotic drug. • A crime involving the transportation, possession, sale or possession for sale, or unlawful use of amphetamines, narcotic drugs, formulations of an amphetamine, or derivatives of narcotic drugs. • A felony or misdemeanor involving moral turpitude. • A felony or serious misdemeanor involving violence. • Leaving the scene of a traffic accident which resulted in personal injury or death. • A felony involving the use of a motor vehicle. B. Conduct resulting in the following: • Any person determined to be a mentally disordered sex offender under the provisions of Article I (commencing with Section 6300), Chapter 2, Part 2, Division 6 of the Welfare and Institutions Code or under similar provisions of law of any other state. • Any person required to register as a sex offender under the provisions of Section 290 of the Penal Code or under similar provisions of law of any other state. Information Form To Obtain Criminal Conviction Information* Please fill out the following information. (Print or Type) 1. Position Title: __________ 2. Name: Last First Middle _________________ 3. Other names you have used: Name: Last First Middle _________________ 4. Sex: [ ] Male [ ] Female 5. Height: _____Feet ______Inches 6. Weight: ________ 7. Eye Color _______ 8. Hair Color ________ 9. Date of Birth: Month Day Year ________ 10. Place of Birth: State _________ 11. Driver’s License Number: _________ 12. Social Security Number: _________ I have read and understand the foregoing Fingerprint Program Notification Form and certify that the information provided herein is correct. Signature: Applicant’s Legal Signature __________________ Date: ________________ * All applicants for employment with VTA shall be fingerprinted. Criminal history information will be obtained to verify the information disclosed on the application. – To Be Completed by Bus Driver Applicants Only – In compliance with Assembly Bill 4045, I am responding to the following inquiry: In the past two (2) years, I HAVE [ ] I HAVE NOT [ ] taken a driving test for employment as a bus driver with any transit property. Signature: _________________ Date: __________________ PAGE 7 of 8 EMPLOYMENT QUALIFICATION INFORMATION SHEET Important Information — Please Read Thoroughly VTA must verify the identity and employment authorization of all new employees to comply with the 1986 Immigration Reform and Control Act. This verification is required only after an offer of employment has been made. For further information regarding the required verification, please contact the Personnel Department at (408) 321-5575. • YOUR DRIVING RECORD WILL BE VERIFIED. Most of VTA’s positions require a valid California driver’s license and a good driving record. You may obtain a copy of your record at the nearest Department of Motor Vehicles office. ANY omissions regarding moving violations received within three (3) years prior to the date of application will be automatic disqualification. • You will be required to complete a pre-employment physical examination, including drug screen. • In accordance with Federal requirements, all persons appointed to safety-sensitive positions are subject to drug/alcohol testing in the following situations: pre-employment (including promotion/demotion or reinstatement); unannounced random; post accident; reasonable suspicion; return to duty (inclusive of follow up testing). • Proof of diplomas, licenses/certifications, etc., must be provided prior to appointment. MANDATORY DISQUALIFICATION OF JOB APPLICANT As a condition of employment you will be fingerprinted for the purpose of obtaining “Criminal Conviction” information from California and Federal record agencies. Each applicant shall disclose on the application form ALL criminal convictions since the age of 18. Failure to disclose ALL convictions shall disqualify an applicant from employment and future employment consideration with VTA. Applicants will be disqualified from employment for criminal misconduct if they have been convicted of or have forfeited bond or collateral upon a charge of a disqualifying public offense listed as follows: • Operating a motor vehicle while under the influence of alcohol, an amphetamine, a narcotic drug, a formulation of an amphetamine, or a derivative of a narcotic drug. • A crime involving the transportation, possession, sale or possession for sale, or unlawful use of amphetamines, narcotic drugs,formulations of an amphetamine, or derivatives of narcotic drugs. • A felony or misdemeanor involving moral turpitude. • A felony or serious misdemeanor involving violence. • Leaving the scene of a traffic accident which resulted in personal injury or death. • A felony involving the use of a motor vehicle. Applicants will be disqualified from employment with VTA for conduct resulting in the following: • Any person determined to be a mentally disordered sex offender under the provision of Article I (commencing with Section 6300), Chapter 2, Part 2, Division 6 of the Welfare and Institution Code or under similar provisions of law of any other state. • Any person required to register as a sex offender under the provisions of Section 290 of the Penal Code or under similar provisions of law of any other state. IMPERSONATION OF APPLICANT IN COMPETITIVE EXAMINATIONS AND OTHER CONDUCT Any person who impersonates another person or permits or aids in any manner any other person to impersonate him/her in connection with any examination or application; furnishes or obtains examination questions or other examination material prepared and intended for use in any examination before such examination; or uses any unfair means to cause or attempt to cause any applicant on an eligible list to waive any rights, may be guilty of a misdemeanor and punishable as such. QUESTIONS REGARDING EXAMINATION PROCESSES Questions regarding the fairness or appropriateness of examination processes should be submitted in writing to the Personnel Manager within (5) working days of taking the test. FOR APPLICANTS WHO DO NOT PASS AN EXAMINATION Provided the examination is given on a continuous basis, applicants who do not pass an examination may reapply 45 days after the initial examination. If the applicant does not pass the second time, the applicant may reapply after another 90 days has elapsed. If the applicant does not pass a third time within a six month period, the applicant may not reapply for another six months. PAGE 8 of 8 EQUAL EMPLOYMENT OPPORTUNITY QUESTIONNAIRE Do Not Detach (Please Print or Type) POSITION TITLE (Write in complete title) ________________ VTA is required by the Federal Government to provide statistical information about applicants and employees to demonstrate that we meet equal employment opportunity requirements. This information will be treated confidentially and will be used for statistical reporting purposes only. The form will be kept in a confidential file separate from the application for employment. ETHNIC ORIGIN [ ] AMERICAN INDIAN OR ALASKAN NATIVE Persons descended from the original peopleof North America and who maintain cultural identification through tribal affiliation or community recognition. [ ] AFRICAN AMERICAN/BLACK(not of Hispanic origin) All persons having origins in any of the Black racial groups of Africa. [ ] ASIAN OR PACIFIC ISLANDER All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands, and Samoa. [ ] HISPANIC/LATINO Includes all persons of Mexican, Puerto Rican, Cuban, Central or South American, other Spanish culture or origin, regardless of race. [ ] WHITE (Caucasian) SEX [ ] Male [ ] Female AGE GROUP [ ] Under 21 [ ] 60 or Over [ ] 50-59 [ ] 40-49 [ ] 30-39 [ ] 21-29 RECRUITMENT RESEARCH (Please indicate below how you became aware of this job opportunity) Newspaper (Name)__________________________ Spanish Newspaper _________________________ Vietnamese Newspaper ______________________ Job Fair (Where) ___________________________ Other _____________________________________ __________________________________________ [ ] Community Organization [ ] Trade or Professional Journal [ ] Employee [ ] Internet [ ] Radio [ ] Exam Notification Card [ ] Announcement Posting [ ] Friend [ ] Television [ ] Telephone Recording DISABILITY [ ] Disability [ ] No Disability If you are disabled, the Personnel Department will make efforts to provide reasonable accommodations in the examination process. If you have special needs, please notify the Personnel Department by calling (408) 321-5575. THIS INFORMATION IS FOR STATISTICAL PURPOSES ONLY AND WILL NOT HAVE ANY EFFECT UPON YOUR APPLICATION.