Version 2018-04-10 Page 1 of 5
Application for Employment
SBMTD is an equal opportunity employer, and does not discriminated on the basis of race, color, creed, ancestry, national origin,
gender, marital status, sexual orientation, gender identity, religion, age, veteran status, physical or mental disability or any category
protected by state or federal law.
POSITION APPLYING FOR:
If indicated on the job description, a current DMV H-6 (10-year driver history) will be required at time of application.
APPLICANT INFORMATION
Last Name
First Name
M.I.
Street Address
Apt #
City State Zip
Phone/Cell #
E-mail
Phone/Cell # (alt)
SSN (optional)
ELIGIBILITY
Do you have a valid driver’s license? YES NO
State
DL #
CLASS
If applying for a BUS OPERATOR position, you must be 21 years or older at time of appointment. Do you meet this requirement?
YES NO
Can you, after a job offer for employment, submit verification of your legal right to work in the United states?
YES NO
Indicate your availability to work the following shifts?
Available Weekends?
YES NO
Available any shift?
YES NO
Do you have any relatives that work at SBMTD or are Members of the Board?
YES NO
If YES, provide name (s)
Have you ever worked for SBMTD?
YES NO
If YES, provide employee ID
EDUCATION
(Proof of education will be required prior to appointment.)
What is the highest level of education you have completed? (check box below)
High School/GED
Some College
Associates (AA)
Bachelors (BA / BS)
Masters/PhD/JD
High School / Colleges / Universities Attended
Course of Study / Type of Degree
# Years completed
Did you graduate?
YES NO
YES NO
YES NO
OTHER RELEVANT COURSES AND TRAINING
Name of Course
Name of Institute
Length of Course
Dates Attended
PROFESSIONAL LICENSE (S) OR CERTIFICATES (S)
Type
Date Issued
Expiration Date
Serial #
LANGUAGES
Other than English, list any languages in which you are fluent:
Speak: Read/Write:
I certify that all statements in this application are true and I agree that any misstatement or concealment of fact may subject me to
disqualification or dismissal. I understand that any offer of employment is contingent upon passing a drug and alcohol test and a fitness
for duty examination for the position for which I am applying. I understand that employment with SBMTD is at-will meaning that I may resign
my employment without giving a reason and SBMTD retains the right to terminate employees at any time, with or without advanced notice
or cause, for any reason not prohibited by law.
INITIAL HERE TO CERTIFY THAT YOU HAVE READ AND AGREE TO THE STATEMENT ABOVE.
NAME: DATE:
click to sign
signature
click to edit
Version 2018-04-10 Page 2 of 5
EMPLOYMENT HISTORY
Beginning with your most recent employer, please list your work history for the last ten years. List each position and promotion
separately. If more space is needed to cover the last ten years, a separate sheet prepared in the same format / or a resume or other
supporting documentation may be attached. An incomplete work history may disqualify you from further consideration.
CURRENT/PREVIOUS EMPLOYMENT
Employer:
From (Mo / Yr):
Job Title:
To
(Mo / Yr):
# Employees Supervised?
Reason for Leaving?
Hours per Week:
Supervisor Name / Title:
Phone:
May we contact? YES NO
List
Duties:
PREVIOUS EMPLOYMENT
Employer:
From (Mo / Yr):
Job Title:
To
(Mo / Yr):
# Employees Supervised?
Reason for Leaving?
Hours per Week:
Supervisor Name / Title:
Phone:
May we contact? YES NO
List
Duties:
PREVIOUS EMPLOYMENT
Employer:
From (Mo / Yr):
Job Title:
To
(Mo / Yr):
# Employees Supervised?
Reason for Leaving?
Hours per Week:
Supervisor Name / Title:
Phone:
May we contact? YES NO
List
Duties:
PREVIOUS EMPLOYMENT
Employer:
From (Mo / Yr):
Job Title:
To
(Mo / Yr):
# Employees Supervised?
Reason for Leaving?
Hours per Week:
Supervisor Name / Title:
Phone:
May we contact? YES NO
List
Duties:
It is SBMTD’s policy, as part of the selection process, to contact your previous employers for employment-related reference information.
Please Note: We will not contact your CURRENT employer unless you authorize us to do so above.
INITIAL HERE TO AUTHORIZE SBMTD TO CONTACT MY PREVIOUS EMPLOYER(s) INDICATED ABOVE.
NAME:
DATE:
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EQUAL EMPLOYMENT OPPORTUNITY - VOLUNTARY SURVEY
To comply with the U.S. Equal Employment Opportunity Commission and California Fair Employment and Housing requirements, Santa
Barbara MTD (SBMTD) is asking all applicants to provide the following information. Data collected will be used only for statistical
purposes to measure the effectiveness of our recruitment efforts.
SBMTD does not discriminate on the basis of race, color, creed, ancestry, national origin, gender, marital status, sexual orientation, religion,
age, veteran status or disability in the provision of services or employment. This portion of the application will be detached, and the
information will not be used to make any employment decision that affects you.
GENDER
Male
Female
Decline to state
AGE GROUP
Under 40
40 or over
Decline to state
ETHNICITY
DO YOU CONSIDER YOUR ETHNIC BACKGROUND TO BE HISPANIC OR LATINO?
Hispanic or Latino means a person of Cuban, Mexican, Puerto Rican, South or Central American or other
Spanish culture.
YES, I am Hispanic or Latino.
NO, I am not Hispanic or Latino.
RACE
STARTING WITH THE 2000 U.S. CENSUS, THE CLASSIFICATION OF HISPANIC/LATINO WAS CHANGED FROM A
RACIAL GROUP TO AN ETHNICITY GROUP. WHETHER OR NOT YOU CHECKED “YES, I AM HISPANIC OR LATINO”
ABOVE, YOU MUST ALSO CHECK A CATEGORY OF RACIAL GROUP BELOW.
WHAT RACIAL GROUP DO YOU CONSIDER TO BE YOUR MOST PREDOMINANT? (CHECK ONLY ONE)
SINGLE RACE
GROUP
CATEGORIES
American Indian or Alaska Native - 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 - A person having origins in any of the original peoples of the Far East, Southeast Asia or the
Indian subcontinent, including for example, Cambodia, China, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand and Vietnam.
Black or African American - A person having origins in any of the Black racial groups of Africa.
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific Islands.
Caucasian (White) - A person having origins in any of the original peoples of Europe, the Middle East or
North Africa. If your origins are from Spain, you should check “Caucasian.”
DUAL RACE
GROUP
CATEGORIES
American Indian or Alaska Native & Black
American Indian or Alaska Native & White
Asian & White
Asian & Black
Black & White
OTHER
Please name the racial group(s)
PLEASE TELL US HOW YOU HEARD ABOUT THIS JOB OPENING?
Job bulletin posting (flyer)
Employee Referral (name):
Newspaper: VC Star, Santa Maria Times
EDD Employment Development Department / Jobs Center
Website: www.SBMTD.gov
Advertisement seen on bus
Website: www.TransitTalent.com
Facebook / Twitter / Instagram (or other social media)
Website: www. craigslist.com
TV / Radio
Another Website (name)
Other:
NAME:
DATE:
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