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Note: You must report all previous employment for the past ten years

I hereby certify that my answers and assertions set forth in this application and supplemental questions are true and complete to the best of my knowledge. I understand that any misrepresentation or material omission of fact on this or any other document required by Jefferson Transit on this application may constitute grounds for rejection, or if employed by Jefferson Transit, for disciplinary measure, including dismissal.

I hereby authorize Jefferson Transit to investigate any aspect of my prior educational and employment history and criminal record.

Furthermore, I understand that if I am hired, employment with Jefferson Transit is "at will," which means that either the company or I can terminate my employment for any reason not prohibited by state or federal law. (Nonrepresented positions only.) 

I also acknowledge that if the position which I am applying includes duties requiring a valid driver’s license with a good record. I will be asked to provide a record, at my expense, if my application is advanced in the review and screening process. 

I also acknowledge that Jefferson Transit is a Drug Free workplace and that any offer of employment is contingent upon submitting to a pre-employment drug and alcohol test. In addition, if the job I am applying for is safety-sensitive, I acknowledge that I may be selected for random drug and alcohol testing in accordance with all applicable FTA regulations. 

An employee or prospective employee receives a written notice explaining the employee's or prospective employee's rights and the limitations imposed, such as prohibited areas of questioning and restrictions on the use of test results. Among other rights, an employee or prospective employee may refuse to take a test, terminate a test at any time, or decline to take a test if he/she suffers from a medical condition. The results of a test alone cannot be disclosed to anyone other than the employer or employee/prospective employee without their consent or, pursuant to court order, to a court, government agency, arbitrator, or mediator.

NOTICE TO JOB APPLICANTS

All applicants for employment with Jefferson Transit Authority must pass a pre-employment drug test prior to employment. As part of your pre-employment physical examination, you are required to submit a urine specimen at a designated collection site. Your urine specimen will be tested at a laboratory to determine the presence of:

• Marijuana
• Cocaine
• Opiates & Opioids
• Amphetamines
• Phencyclidine
• MOMA
• 6-Acetylmorphine

Following a conditional offer of employment, you must pass this test prior to beginning employment. A verified positive test result will disqualify you for employment for a period of not less than one year. Evidence of the absence of drug or alcohol dependency from a substance abuse treatment provider or other qualified medical or mental health practitioner and re-testing will be required prior to further consideration for employment.

Additionally, if you are selected for employment, you will be required to report to the transit Human Resources Manager within five (5) days any conviction for violation of a criminal drug statute.

Records will be retained for five years on candidates not passing this pre-employment test.

Refusal to test, specimen tampering during the pre-employment medical evaluation, falsification of the substance use form or failure to provide an adequate specimen without a valid medical explanation will be considered a positive test and grounds for disqualification from employment.

Certification: I have read and understand this notice and agree to all of the provisions thereof:

The information requested below will be used for statistical purposes only as required by the Equal Opportunity laws and regulations. The information requested is voluntary and confidential.

Thank you for helping evaluate the effectiveness of our equal opportunity effort.