PERSONAL INFORMATION
POSITION INFORMATION
EDUCATION
List educational institutions you have attended:
WORK HISTORY
List most recent employer first. You may include military service and training. NOTE: YOU MUST COMPLETE THIS SECTION
EVEN IF ATTACHING A RESUME. FAILURE TO COMPLETE COULD JEOPARDIZE CONSIDERATION.
Work References
Name
Professional Relationship
Work Phone Number
Home Phone Number
THE FOLLOWING POINTS ARE VERY IMPORTANT. PLEASE READ THEM CAREFULLY BEFORE SIGNING THIS APPLICATION
I authorize investigation of all statements contained in this application. I will not hold AVTA or any of my previous employers liable in any
respect if an employment offer is not forthcoming, is withdrawn, or if my employment is terminated as a result of misrepresentation or
omission of facts on this application. I understand that if I am employed by AVTA, additional personal data may be required for
determination of benefits, statistical purposes, and legal compliance.
I understand that all offers of employment are also conditional on my successfully completing a background and drug and alcohol screening.
This will be performed at AVTA's designated medical facility and at AVTA's expense. I further understand that if this screening is not
successful, all offers of employment will be withdrawn. I also understand that AVTA's policy prohibits the use, sale, or possession of illegal
drugs or non-prescribed controlled substances, as well as alcohol, while on the Authority's time and that if I am employed by AVTA such
activity may result in immediate termination of my employment.
I also understand that if I am employed by AVTA, my employment is "at will." This means that my employment may be terminated by me or
AVTA, at any time, for any reason, with or without notice. In addition, the terms and conditions of my employment may be changed at any
time, with or without notice, including but not limited to promotion, demotion, transfer, compensation, benefits, duties and location of work. I
further understand that my status as an "at will" employee cannot be changed except through written agreement signed by the Executive
Director or the decision of the Board of Directors of AVT A.
I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE AND AGREE TO EACH AND ALL OF THESE STATEMENTS:
SELF-IDENTIFICATION OF GENDER & EEO STATUS FORM
As an Affirmative Action Employer, AVTA is required and requests the cooperation of all interested
applicants in identifying their gender and EEO status. This information will be summarized and
included in our current Affirmative Action Program without disclosing the name of the individual.
Please be advised that all information obtained on this form will be kept separate from the Application
for Employment and in a separate confidential file. Thank you in advance for your cooperation.
EEO Status Selection
Please pick one race with which you most strongly identify:
