Last Revision 9/2/2020

665 Franklin Avenue NE., St. Cloud MN 56304 320.529.4498

EMPLOYMENT APPLICATION Notice to the Applicant:

We welcome you as an applicant for employment with Metro Bus. It is our policy to hire the most qualified applicant for the position. Metro Bus will not discriminate against or harass any employee or applicant for employment because of race, color, creed, religion, national origin, gender, disability, sexual orientation, age, veteran status, familial status, marital status, status with regard to public assistance or local human rights commission activity. Metro Bus will take affirmative action to ensure that all employment practices are free of such discrimination.

Position Applied for Date of Application

Personal InformationFirst Name: __________________________________ MI: _______ Last Name: _________________________________________

Address: ________________________________________ City: __________________________ State: ______ ZIP: ____________

Home Phone: _______________________________________ Cell Phone: ____________________________________________

E-mail:________________________________________________________________________________________________________

Education InformationType of School Name and Address of School Degree Obtained (include Major/Minor)High School

College/University

Other

Military Record- If applying for Veteran’s Preference, a DD214 must accompany this application.Branch: Type of Discharge:

Member of Reserves/Guards? ☐ Yes No Active Other If you are applying for Veteran’s Preference as a Qualified Military Spouse, you must provide appropriate documentation with application.

Driving Information – Complete For Bus Operator, Fueler & Mechanic PositionsDRIVER’S LICENSE INFORMATION Driver’s License Number:__________________________ Class: _______________________ State of Issue: ____________________ Passenger Endorsement? Yes No Airbrakes? Yes No

Has your driver’s license ever been revoked, suspended or renewal denied? Yes No

If yes, when and why:________________________________________________________________________________________________

CDL PERMIT INFORMATION Do you have a Class A or B CDL Permit? Yes No State of Issue: ____________________ Passenger Endorsement? Yes No Airbrakes? Yes No

Last Revision 9/2/2020

Driving Accident Information – Complete For Bus Operator, Fueler & Mechanic Positions List all vehicle accidents in which you have been involved within the past three years.

Nature of accident Date Injuries or fatalities Were you considered negligent?

Driving Experience Record – Complete For Bus Operator, Fueler & Mechanic PositionsClass of Equipment Type of equipment

(van, tank, flat, etc.) Dates (from-to) Approximate number of total miles

Employment HistoryInclude employment for the past three years starting with the most recent. If applying for Bus Operator, Fueler or Mechanic include all driving positions. Are you currently employed? Yes No May we contact your current employer? Yes No If yes, why do you want to change jobs: Employer number 1 (Most recent/Current)Employer: Phone: Address:City, State, Zip: Dates employed From: _________ To: _________ Job title: Supervisor’s Name:Nature of duties: Reason for leaving: Salary:Employer number 2 (Next most recent)Employer: Phone:Address: City, State, Zip: Dates employed From: _________ To: _________Job title: Supervisor’s Name: Nature of duties:Reason for leaving: Salary: Employer number 3 (Next most recent)Employer: Phone: Address:City, State, Zip: Dates employed From: _________ To: _________ Job title: Part time Full time Supervisor’s Name:Nature of duties: Reason for leaving: Salary:Employer number 4 (Next most recent)Employer: Phone:Address: City, State, Zip: Dates employed From: _________ To: _________Job title: Part time Full time Supervisor’s Name: Nature of duties:Reason for leaving: Salary: Employer number 5 (Next most recent)Employer: Phone: Address:City, State, Zip: Dates employed From: _________ To: _________ Job title: Part time Full time Supervisor’s Name:Nature of duties: Reason for leaving: Salary:

Part time Full time

Part time Full time

Yes No

Yes No

Last Revision 9/2/2020

References: List references, other than relatives, who you have known for at least one year.Name Phone number(s) Relationship to you

Special Skills and QualificationsDescribe any skills, experiences and special accomplishments that better qualify you for this position.

How did you come to seek employment with Metro Bus?

☐ Radio ☐ Metro Bus Signs ☐ Social Media/Digital (please specify):________________________________

☐ Metro Bus Employee (name):___________________________________________________________________________

☐ Print Media (please specify):____________________________________________________________________________

☐ Other (please specify):__________________________________________________________________________________

By signing this application, I certify that information given herein is true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary to arrive at an employment decision. I understand that this application is not, and is not intended to be, a contract of employment. In the event I am employed, I understand that false or misleading information given in this application or interview may result in discharge. I also understand that I am required to abide by all rules and regulations of Metro Bus.

I authorize Metro bus to investigate previous employment, educational background and references.

☐ My typed name below shall have the same force and effect as my written signature

Signature: _________________________________________________________________ Date: ____________________________

Last Revision 9/2/2020

Data Privacy Notice In accordance with the Minnesota Government Data Practices Act, Metro Bus is required to inform you of your rights as they pertain to the private information collected from you. Private data is that information which is available to you but not the public. The personal information we collect about you is private.

Minnesota Statutes 13.01 to 13.87 on Government Data Practices require you be informed that the following information, which you are asked to provide on the application for employment, is considered private data:

1. Name2. Home address3. Home phone number4. Social Security number5. Date of birth6. Conviction record7. Sex8. Age group9. Disability type

We ask this information for the following reasons: • To distinguish you from all the other applicants and identify you in our personnel files• To enable us to verify that you are the individual who makes the application• To enable us to contact you when additional information is required, send notices to you and/or schedule

you for interviews• To determine if you meet the minimum age requirements, if any• To determine whether or not your conviction record may be a job related consideration affecting your

suitability for the position you applied for• To enable us to ensure your rights to equal opportunities• To meet Federal and State reporting requirements• To make processing more efficient

The data supplied by you may be used for such other purposes as may be determined to be necessary in the administration of personnel in Metro Bus and the policies, rules and regulations promulgated pursuant thereto.

Furnishing Social Security number, date of birth (unless a minimum age is required), sex, age group and disability data is voluntary, but refusal to supply other requested information will mean that your application for employment may not be considered.

Private data is available only to you and to other persons in the Metro Bus offices who have a bona fide need for the data. Public data is available to anyone requesting it and consists of all data furnished in the employment process, which is not designated in this notice as private data.

If Metro Bus hires you, you will be legally required to supply your Social Security number and all applicable tax information. This information will be sent to Federal and State tax authorities and to the Social Security Administration, and will enable us to compute your salary deductions. Insurance data, which you will be required to furnish in order to participate in Metro Bus health and life insurance plans, will be classified as private, as well as payroll deduction data.

In accordance with Minnesota Statues 13.03 and 13.04, I have been informed and of and understand my rights as a subject of data.

☐ My typed name below shall have the same force and effect as my written signature

Signature: _________________________________________________________________ Date: ____________________________

Last Revision 9/2/2020

Self-Identification Form

This employer is subject to certain nondiscrimination and affirmative action recordkeeping and reporting requirements, which require the employer to invite employees to voluntarily self-identify. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable federal laws, executive orders and regulations, including those, which require the information to be summarized and reported to the Federal Government for civil rights enforcer purposes. If you choose not to self-identify at this time, the federal government requires this employer to determine this information by visual survey and/or other available information. For civil rights monitoring and enforcement purposes only, all race/ethnicity information will be collected and reported in the seven categories identified below. The definitions for each category have been established by the federal government. If you choose to voluntarily self-identify, you may mark only one of the boxes presented below. The information will not be maintained with your application, or if hired, your personnel file.

NAME GENDER Male Female

RACE/ETHNICITY Please mark one box that describes the race/ethnicity category with which you primarily identify. A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race A person having origins in any of the original peoples of Europe, the Middle East or North America. A person having origins in any of the Black racial groups of Africa.

☐ Hispanic/Latino

☐ White☐ Black or African American ☐ Native-Hawaiian orother Pacific Islander

A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands A person having origins in any of the original people of the Far East, Southeast Asia or the Indian subcontinent including, for example, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. 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.

☐ Asian

☐ American Indian or Alaska Native

☐ Two or More Races All persons who identify with more than one of the above five races. VETERAN STATUS Using the definitions as stated in Form DD214, please check the box or boxes below to identify yourself in as many covered veterans categories as apply.

NO Disabled Veteran NO Other Protected Veteran NO Recently Separated Veteran (within last 36 months) - Discharge/Release Date:_______________________________ NO Armed Forces Service Medal Veteran

DISABILITYA “disabled individual” means any person who has a physical or mental impairment that substantially limits one or more of such person’s major life activities, has a record of such impairment or is regarded as having such impairment. Using the definition as stated above, please check the box below to identify yourself as a disabled individual.

☐ Non-Participation: I have read the above statement and I have chosen not to complete this form.

☐ My typed name below shall have the same force and effect as my written signature

Signature: _________________________________________________________________ Date: ____________________________

YESYESYESYES

YES NO

Position Applied forRow1: Date of ApplicationRow1: First Name: MI: Last Name: Address: City: State: ZIP: Home Phone: Cell Phone: Email: Name and Address of SchoolHigh School: Degree Obtained include MajorMinorHigh School: Name and Address of SchoolCollegeUniversity: Degree Obtained include MajorMinorCollegeUniversity: Name and Address of SchoolOther: Degree Obtained include MajorMinorOther: Branch: Type of Discharge: Drivers License Number: Class: State of Issue: If yes when and why: State of Issue_2: Nature of accidentRow1: DateRow1: Injuries or fatalitiesRow1: Nature of accidentRow2: DateRow2: Injuries or fatalitiesRow2: Phone: Address_2: City State Zip: Job title: Supervisors Name: Nature of duties: Reason for leaving: Salary: Employer_2: Phone_2: Address_3: City State Zip_2: To_2: Job title_2: Supervisors Name_2: Nature of duties_2: Reason for leaving_2: Salary_2: Employer_3: Phone_3: Address_4: City State Zip_3: To_3: Job title_3: Supervisors Name_3: Nature of duties_3: Reason for leaving_3: Salary_3: Employer_4: Phone_4: Address_5: City State Zip_4: To_4: Job title_4: Supervisors Name_4: Nature of duties_4: Reason for leaving_4: Salary_4: Employer_5: Phone_5: Address_6: City State Zip_5: To_5: Job title_5: Supervisors Name_5: Nature of duties_5: Reason for leaving_5: Salary_5: Describe any skills experiences and special accomplishments that better qualify you for this position: Metro Bus Signs: OffSocial MediaDigital please specify: Radio: OffMetro Bus Employee name: Print Media please specify: My typed name below shall have the same force and effect as my written signature: OffDate: My typed name below shall have the same force and effect as my written signature_2: OffDate_2: NAME: Recently Separated Veteran within last 36 months DischargeRelease Date: NonParticipation I have read the above statement and I have chosen not to complete this form: OffMy typed name below shall have the same force and effect as my written signature_3: OffDate_3: Group1: OffGroup2: OffGroup3: OffGroup4: OffGroup5: OffGroup6: OffGroup7: OffGroup8: OffGroup9: OffClass of EquipmentRow1: Type of equipment van tank flat etcRow2: Group10: OffGroup11: OffTo: Group12: OffFrom: Group13: OffGroup14: OffGroup15: OffGroup16: OffNameRow1: NameRow2: Group17: OffGroup18: OffGroup19: OffGroup20: OffGroup21: OffGroup22: OffGroup23: OffType of equipment van tank flat etcRow1: Dates fromtoRow1: Approximate number of total milesRow1: Class of EquipmentRow2: Dates fromtoRow2: Approximate number of total milesRow2: Class of EquipmentRow3: Type of equipment van tank flat etcRow3: Dates fromtoRow3: Approximate number of total milesRow3: Employer: Why change jobs?: From2: From3: From4: From5: Phone numbersRow1: Relationship to youRow1: NameRow3: Phone numbersRow3: Phone numbersRow2: Relationship to youRow2: Relationship to youRow3: Social Media/Digital button: OffMetro Bus Employee button: OffPrint Media Button: OffOther button: OffOther please specify: Signature 2: Signature 3: Signature 1: