Employment Application Form - Maryland Transit Administration Page 3
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4C. RELATIVES EMPLOYED BY THE MTA OR MDOT MODAL:
If you have any relatives employed at the MTA or another MDOT modal/agency, please provide the requested information below.
Note: A relative is defined as husband, wife, brother, sister, mother, father, grandparent, cousin; and in-law or step relatives as previously defined.
Relative’s Name: ________________________________________ Relationship: ____________________ Modal/Agency: _______________
(Last Name, First Name)
Relative’s Name: ________________________________________ Relationship: ____________________ Modal/Agency: _______________
(Last Name, First Name)
D. PREVIOUS MTA or MDOT EMPLOYMENT:
Have you previously applied for a MTA or another MDOT modal/agency position, or have you been previously employed by either? _____
IfYES, provide information:
Date
to
From
Department
Position
Date
_______ to ______
_______________________
__________________________
_______
_______ to ______
_______________________
____________________________
_______
E. DRIVING LICENSE INFORMATION:
Applicants for a position requiring a driver’s license must provide the information below.
Complete the following information if you have a VALID driver’s license:
License Number: __________________________________ Expiration Date: ___________ License Class:___
Issued by State of:______
(mm/dd/yy)
Are there any moving violations pending against you? (Circle One) YES NO
Are there any restrictions or endorsements on your license? (Circle One) YES NO
If you answer YES to either question, please explain:
_____________________________________________________________________________________________________
Complete the following information if you have a CURRENT CDL:
CDL Endorsements: _____________
CDL Expiration Date:___________
CDL Class: ______
CDL Restrictions: ______________
F. DISMISSALS AND/OR FORCED RESIGNATIONS
Please write YES or NO in response to the following questions.
Have you ever been dismissed from any position or asked to resign?
_______
If answering YES to either question, please explain.
_____________________________________________________________________________________________________________________
CERTIFICATION
(Please read the following statement, sign, and date as appropriate.)
I certify that all information contained on this application and attachments is true and complete to the best of my
knowledge and belief. I authorize the Maryland Transit Administration to contact all sources necessary to verify this
information. I understand that any erroneous, misleading, or fraudulent information is sufficient grounds for
withdrawal of an offer of employment or immediate discharge.
Signature of Applicant: ________________________________________
Date Signed: ____________
BLANK
S ECTION
MJ45
Page 3 of 4
Revised 03/2013
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Parent category: Business