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: | | |
| | | | |
|Home Phone #: |( ) - |Cell Phone#: |( ) - |
| | | | |
|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: ________________________________ - ____________________ |
| |
|Interviewer's Signature: ___________________________________________________________________ |
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