Employment Application

1 General Information

2 Education and Experience

3 Documents and Consent

Position Sought*
How did you learn about the position?*
Name
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Available Start Date?*
Desired Salary?*
Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction?*
- Yes
- No
Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?*
- Yes
- No
If selected for employment, are you willing to obtain a chauffeurs or CDL-A (air brakes/combo) license?*
- Yes
- No
If selected for employment, are you willing to submit to a pre-employment drug screening test?*
- Yes
- No

Education*
High School & College Name Location Years Attended Degree Received Major
Other training, certifications, or licenses held:
List other information pertinent to the employment you are seeking:
Experience #1*
Employer Job Title Salary Dates Employed Supervisors Name Supervisors Phone Number
Please list the most recent first.
Experience #1 Duties*
Experience #1 Reason for Leaving*
Experience #2
Employer Job Title Salary Dates Employed Supervisors Name Supervisors Phone Number
Please list the most recent first.
Experience #2 Duties
Experience #2 Reason for Leaving
Experience #3
Employer Job Title Salary Dates Employed Supervisors Name Supervisors Phone Number
Please list the most recent first.
Experience #3 Duties
Experience #3 Reason for Leaving

Indiana Motor Vehicle Record*
Please purchase a Indiana Motor Vehicle Record and attach it here. You can purchase the record at https://www.in.gov/bmv/2489.htm.
Resume
If you have a current resume, please upload with the application.
Consent*
I agree to the privacy policy.
-GridLock Traffic Systems, Inc. is an Equal Opportunity/Affirmative Action Employer committed to excellence through diversity. Employment offers are made on the basis of qualifications and without regard to race, color, sex, sexual orientation,
gender identity, religion, national or ethnic origin, disability, age, or veteran status.
-I certify that answers given herein are 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 in arriving at an employment decision.
-This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
-I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed
by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
-In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer
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High School & College Name	Location	Years Attended	Degree Received	Major