CONNECTICUT DEPARTMENT OF TRANSPORTATION INTERVIEW …



CONNECTICUT DEPARTMENT OF TRANSPORTATION MAINTENANCE INTERVIEW FORM | |

New Hire and/or Inter Agency Recruitment

(Page 1)

|Please read directions below before completing this form. Print Clearly. |

|Complete this form during the interview. Apply the same interviewing criteria for all applicants being interviewed. |

|Questions listed are intended as guides and should be answered if they relate to the specific job for which interviews are being conducted. |

|Complete the "Overall Rating Section" as indicated. |

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|Title Interviewed for: |      |Employment |Transfer | |

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|Applicant Name: |      |

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|Present Class: |      |Seniority: “YY/MM/DD” |  /  /   |

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|Address: |      | |

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|Home Phone #: |( )     -      |Cell Phone#: |(   )    -     |

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|Date/Time of Interview: |/ / |Interviewer's Name: |      |

Discuss the applicable items in this section and check off:

Title of position, essential requirements of the job and salary: Working Conditions

Winter Storm Policy: Sick Leave Policy: Drug & Alcohol Policy:

Policy NO. EX.O. - 26 Employment of Relatives:

This position requires mandatory overtime during the snow and ice season. Do you have any obligations that would interfere or conflict with this responsibility?__________________________

Are you currently employed with any consultant, contractor, appraiser, or any other organization or individual which is under contract or agreement with the State of Connecticut, or who may be doing business with the State of Connecticut, which could cause, or create the appearance of, a conflict with or influence the performance of your duties with the Department as they were explained to you?

Yes No If yes, explain the potential conflict and provide details re: name, address,

etc. of the company/individual/organization: ___________________________________________________

________________________________________________________________________________________________

Travel Distance to work:_______________________ Approximate Commute Time:________________

The essential functions/duties of the job have been described to you. 

Are you able to perform them with or without an accommodation? Yes No

Are you presently legally authorized to work full time in the United States? ______________

Do you read, write and understand English? ______________________________________________

|CONNECTICUT DEPARTMENT OF TRANSPORTATION MAINTENANCE INTERVIEW FORM |

New Hire and/or Inter Agency Recruitment

(Page 2)

Questions to be asked ONLY when interviewing/hiring into positions requiring a Commercial Drivers License (CDL):

Have you ever tested positive for drugs? ________________________________________________

Have you ever tested positive for alcohol? ______________________________________________

If yes, have you successfully completed the Return-to-Duty process, which includes, evaluation by a Substance Abuse Professional (SAP) as a result of any positive test results? ______________

(Documentation will have to be provided by applicant prior to being considered for employment)

Education & Training:

Highest grade completed: _______ College Degree: Yes No Type:_________ Major:_____________

Technical/Business School: No Yes Specify:___________________________________________

Technical/Military Service: No Yes Specify:___________________________________________

Previous State Service: No Yes Specify:___________________________________________

___________________________________________________________________________________________________

Describe your experience/training with computers and types of computer applications (if applicable): ___________________________________________________________________________________

Licenses:

Commercial Driver’s License: Class: __________ Endorsements (Airbrakes, Tanker): __________________

How long have you had a CDL? ________________

Describe your CDL Driving Experience (type of vehicles driven) ___________________________________________________________________________________________________

___________________________________________________________________________________________________

Medical Examiners Card: Yes No Date of Expiration:________________________________

Explain any accidents with your Commerical Driver’s License (CDL) while on the job: ___________________________________________________________________________________________________

___________________________________________________________________________________________________

Do you have any special licenses (Welding, Electrical): (Attach copy)______________________________

___________________________________________________________________________________________________

Describe your experience operating various pieces of equipment(type/how long): ___________________

___________________________________________________________________________________________________

Have you had any accidents/incidents while on the job which resulted in damage to equipment?

If so, please describe:___________________________________________________________________________

___________________________________________________________________________________________________Describe your experience with equipment repair and the types of equipment worked on (how long): _____________________________________________________________________________________________________________________________________________________________________________________________________________________

|CONNECTICUT DEPARTMENT OF TRANSPORTATION MAINTENANCE INTERVIEW FORM |

New Hire and/or Inter Agency Recruitment

(Page 3)

Work History:

Explain any experience you may have with regard to snow plowing operations: ______________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

What other experience or education do you have that relates to the duties previously described

to you? ___________________________________________________________________________________________

___________________________________________________________________________________________________

Explain reasons for any breaks in your employment history: ________________________________________

___________________________________________________________________________________________________

Explain reasons for any termination(s) from previous employment: ___________________________________________________________________________________________________

___________________________________________________________________________________________________

Were you ever disciplined by an employer? If so, explain: ________________________________________

___________________________________________________________________________________________________

Have you ever exhibited any inappropriate or violent behavior related to the workplace?

If so, explain: __________________________________________________________________________________

___________________________________________________________________________________________________

How would DOT benefit from hiring you? ____________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

Do you have any concerns that would preclude you from accepting this position if it were

offered to you? __________________________________________________________________________________

Do you have any questions for the panel? _________________________________________________________

___________________________________________________________________________________________________

Is there any additional information you would like to add?________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

Geographic Preferences:

Admin. Office Rocky Hill(D1) Norwich(D2) New Haven(D3) Thomaston(D4)

None Other:______________________________________________________________________

(include relocation information)

|OVERALL RATING SECTION |

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|Eligible for Appointment Not eligible for Appointment |

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|Interviewer's Printed Name and Title: ________________________________ - ____________________ |

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|Interviewer's Signature: ___________________________________________________________________ |

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