TEST PAGE Demographic DataName* First Middle Last Suffix Sex (if identified)ChooseMaleFemaleNon-BinaryAddress* Street Address Address Line 2 City ChooseAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mobile Phone*Email Address* Driver’s License #*License Class*Class D (regular operator)Class C (Commercial)Class B (Commercial)Class A (Commercial)License State* AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Driver License Issue Date* MM slash DD slash YYYY Driver License Expiration Date* MM slash DD slash YYYY Date of Birth* MM slash DD slash YYYY CORI History* MM slash DD slash YYYY Driver’s History Record* MM slash DD slash YYYY Scheduling InformationWork ScheduleMonday -ThursdayTuesday – FridayMonday – FridaySaturday – SundayNot Yet DeterminedShift*First ChoiceSecond ChoiceThird ChoiceZone*12345FloaterNot Yet DeterminedVehicle*AssignedDepotNot Yet DeterminedHire Date* MM slash DD slash YYYY Start Date* MM slash DD slash YYYY 90 Day Review Date* MM slash DD slash YYYY Starting Hourly Rate*Bonus Eligible* Yes No Bonus AmountCertificationsCompany Training Certificate* Yes No Training Certificate Date MM slash DD slash YYYY Sexual Harassment Certificate* Yes No Harassment Certificate Date MM slash DD slash YYYY GATRA Name & Date of Birth Check* Yes No GATRA Name DOB Date MM slash DD slash YYYY GATRA Safety Driving Scheduled* Yes No GATRA Scheduled Date MM slash DD slash YYYY Wheelchair Attestment Document* Yes No Wheelchair Document Date MM slash DD slash YYYY InstructorsDriver Trainer First Last Date of Driver Training MM slash DD slash YYYY Software Training First Last Date of Software Training MM slash DD slash YYYY Safety and Compliance Training First Last Date of Safety Training MM slash DD slash YYYY People OperationsALL Handbook Sections Completed* Yes No Handbook Date MM slash DD slash YYYY I-9 Verification Documented (FED)* Yes No I-9 Date MM slash DD slash YYYY W-4 Form Completed (FED)* Yes No W4 Date MM slash DD slash YYYY Direct Deposit Form (CPS)* Yes No Direct Deposit Form Date MM slash DD slash YYYY Additional CommentsAdditional CommentsPhoneThis field is for validation purposes and should be left unchanged.
