Blank Michigan 0999D PDF Form

Blank Michigan 0999D PDF Form

The Michigan 0999D form is an employment application used by the Michigan Department of Transportation. This form collects essential information about applicants, including their work history, personal details, and qualifications. Completing this form is a crucial step in applying for a position within the department.

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The Michigan 0999D form is a critical document for individuals seeking employment with the Michigan Department of Transportation (MDOT). This application is essential for anyone applying for a position within the department, as it collects vital information regarding the applicant's personal details, work history, and qualifications. The form requires applicants to provide their name, contact information, and job title for which they are applying, along with details about previous employment and education. It also includes sections for applicants to disclose their veteran status, citizenship, and any disabilities, ensuring compliance with equal opportunity employment laws. Additionally, the form emphasizes the importance of truthfulness, as any inaccuracies may affect employment considerations. Completing this application accurately is crucial for candidates looking to join MDOT, as it serves as the first step in the hiring process.

Document Sample

of Transportation

EMPLOYMENT APPLICATION

Page 1 of 3

Michigan Department

 

0999D (01/07)

Equal Opportunity Employer

 

 

 

A MDOT APPLICATION IS REQUIRED, resumes are encouraged, but are not a substitute for the application. Submit application to Office of Human Resources, 934 Bridge Plaza, Sault Ste. Marie, Michigan 48783. Fax Number: (906) 635-0540.

POSITION FOR WHICH YOU ARE APPLYING

Posting Code: _______________________________________________ Bureau/Region/Office/Division: __________________________________

Position Location: _____________________________________________ JOB TITLE: _______________________________________________

Are you or have you ever been a State of Michigan employee?

 

Yes

 

No If Yes, Employee ID # required: _________________

If you have a disability, as defined by the Michigan Persons with Disabilities Civil Rights Act, and require assistance to complete this application, a reasonable accommodation may be provided.

PERSONAL INFORMATION

Name: __________________________________________________________________________________________________________________

Mailing Address: _________________________________________________________________________________________________________

City: _________________________________________________________________ State: _________________ Zip Code: __________________

Email Address: _______________________________________________

Drivers License Number: ______________________________________

Day Time Telephone Number: (_______) __________________________

Home Telephone Number: (_______) _____________________________

Previous name(s) if different than current name: _________________________________________________________________________________

Have you ever been dismissed from employment or resigned your employment in lieu of dismissal?

Yes

No

If Yes, when and please explain: _____________________________________________________________________________________________

NAME/LOCATION OF HIGH SCHOOL:

DIPLOMA:

Yes

No

Other (Specify) ______________

COLLEGE, UNIVERSITY, TRADE SCHOOL OR SPECIAL TRAINING: (TRANSCRIPTS ARE REQUIRED)

NAME OF SCHOOL

LOCATION

CREDIT HOURS EARNED

QTR SEM

COURSE OF STUDY

DEGREE OR CERTIFICATE RECEIVED

TRADE SCHOOL/SPECIAL TRAINING

TRADE SCHOOL/SPECIAL TRAINING

YOUR NAME, IF DIFFERENT WHILE ATTENDING SCHOOL: _____________________________________________________________________

LICENSURE OR REGISTRATION EXAMPLES: CDL, PE, CPA, ETC.

LICENSURE OR REGISTRATION

NUMBER

DATE RECEIVED

EXPIRATION DATE

STATE LICENSING AGENCY

VETERAN:

Are you a veteran, surviving spouse or a spouse of a disabled veteran who has been discharged within the last five years?

 

Yes

 

No

If yes, are you registered with Civil Service for veterans’ preference?

 

Yes

 

No

 

 

 

 

CITIZENSHIP:

Are you a U.S. Citizen?

 

Yes

 

No

 

 

 

 

 

If No, are you eligible to work in the U.S. without sponsorship?

 

 

Yes

 

No

Do you possess a valid Western Hemisphere Travel Initiative Document: ______Passport

______ Passport Card ______NEXUS ______ Other

 

 

 

 

 

If "Other", please specify: ______________________________________

MDOT 0999D (01/07)

Page 2 of 3

PERIODS OF EMPLOYMENT

Describe your work experience in detail, beginning with your current or most recent job. Include job related voluteer work, if applicable, and indicate number of employees supervised. Use a separate block to describe each position. If needed, attach additional sheets, using the same format as the application. Resumes may be attached to provide additional information.

1Name of Present or Last Employer: _______________________________________________________________________________________

Address: ___________________________________________________________________ Phone No.: (________)__________________________

Your Job Title: ________________________________________________

Supervisor’s Name: __________________________________________

FROM: _______/_______/_______ TO: _______/_______/_______

HOURS PER WEEK: _______ (________________________________)

MONTH DAY

YEAR

MONTH DAY

YEAR

YOUR NAME IF DIFFERENT DURING EMPLOYMENT

Duties and Responsibilities: _______________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

Reason for Leaving: ______________________________________________________________________________________________________________________

2Name of Present or Last Employer: _______________________________________________________________________________________

Address: ___________________________________________________________________ Phone No.: (_______)___________________________

Your Job Title: ________________________________________________

Supervisor’s Name: __________________________________________

FROM: _______/_______/_______ TO: _______/_______/_______

HOURS PER WEEK: _______ (________________________________)

MONTH DAY

YEAR

MONTH DAY

YEAR

YOUR NAME IF DIFFERENT DURING EMPLOYMENT

Duties and Responsibilities: _______________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

Reason for Leaving: ______________________________________________________________________________________________________________________

3Name of Present or Last Employer: _______________________________________________________________________________________

Address: ___________________________________________________________________ Phone No.: (________)__________________________

Your Job Title: ________________________________________________

Supervisor’s Name: __________________________________________

FROM: _______/_______/_______ TO: _______/_______/_______

HOURS PER WEEK: _______ (________________________________)

MONTH DAY

YEAR

MONTH DAY

YEAR

YOUR NAME IF DIFFERENT DURING EMPLOYMENT

Duties and Responsibilities: _______________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

Reason for Leaving: ______________________________________________________________________________________________________________________

CERTIFICATION

I certify that all information contained in this application is true, and made in good faith. I agree and understand any falsifications, omissions, misstate- ments, or misrepresentations above will result in my forfeiting any rights of consideration for employment with the Michigan Department of Transportation or, if hired, could lead to my dismissal. Under the Michigan Persons with Disabilities Civil Rights Act, a person with a disability may allege a violation of the Act regarding the failure to accommodate only if the person with a disability notifies the employer in writing of the need for accommodation within 182 days after the date the person with a disability knew or reasonably should have known an accommodation was needed. This does not preclude my rights under federal law which establishes a 300 day status of limitation.

By submission of this application, I am authorizing the Michigan Department of Transportation to conduct a criminal history and background check, contact past employers regarding references and to check my motor vehicle operator license record as part of the pre-employment process.

SIGNATURE: ___________________________________________________________________________ DATE: _________________________

MDOT 0999D (01/07)Page 3 of 3

_EEO SURVEY

 

 

 

 

_

 

 

 

 

 

Although the following information is not mandatory, it is requested to comply with Federal Highway Administration (FHWA) require-

_

 

 

 

 

 

ments. This information is for statistical purposes only. It will in no way affect your employment status or opportunities, nor will it be

_

 

 

 

 

 

used as part of the selection process (hiring managers will not receive this information).

___Posting Code: _______________________________________________

Bureau/Region/Office/Division: __________________________________

__Position: ___________________________________________________

Location of Position___________________________________________

____

 

MALE

 

FEMALE

 

GENDER:

 

 

 

____

 

 

 

 

 

DISABLED:

 

NO

 

YES

 

__

 

 

 

 

 

process._ __

__ selection_ __

the__ to__

prior_ __ section_ __

this__

remove__ __

Employer,__

_

__ _ _

RACE/ETHNICITY (Please select all that apply to you):

American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America).

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black: (not of HISpanic origin): A person having origins in any of the black racial groups.

Hispanic or Latino: A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish origin.

Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White (not of Hispanic origin): A person having origins in any of the original peoples of Europe, North Africa, or Middle East.

Multiracial: A person having origins in more than one racial group.

File Specifics

Fact Name Details
Form Name Michigan Department of Transportation Employment Application (Form 0999D)
Governing Law Michigan Persons with Disabilities Civil Rights Act
Submission Method Applications can be submitted via mail or fax to the Office of Human Resources.
Contact Information Office of Human Resources, 934 Bridge Plaza, Sault Ste. Marie, Michigan 48783. Fax: (906) 635-0540.
Application Requirement A completed application is mandatory; resumes are optional and not a substitute.
Disability Accommodations Reasonable accommodations may be provided for applicants with disabilities.
Veteran Preference Applicants may indicate veteran status for potential preference in hiring.
Certification Requirement Applicants must certify that all information provided is true and complete.
Criminal Background Check Submission authorizes MDOT to conduct a criminal history and background check.
EEO Survey Optional demographic information is collected for statistical purposes to comply with federal requirements.

How to Use Michigan 0999D

Filling out the Michigan 0999D form is a straightforward process. This application is essential for those seeking employment with the Michigan Department of Transportation. Make sure you have all necessary information at hand before you begin. Follow these steps carefully to ensure your application is complete and accurate.

  1. Position Information: At the top of the form, fill in the Posting Code, Bureau/Region/Office/Division, and Position Location you are applying for. Include the Job Title.
  2. State Employment: Indicate if you are or have ever been a State of Michigan employee. If yes, provide your Employee ID.
  3. Personal Information: Fill in your Name, Mailing Address, City, State, Zip Code, and Email Address. Include your Driver's License Number and daytime and home telephone numbers.
  4. Previous Names: If your name has changed, list any Previous Names.
  5. Employment History: Describe your work experience, starting with your current or most recent job. For each job, include the Name of Employer, Address, Phone Number, Your Job Title, Supervisor’s Name, Employment Dates, Hours per Week, Duties and Responsibilities, and Reason for Leaving. Repeat this for up to three jobs.
  6. Education: Provide details about your education. List the Name/Location of High School and whether you received a Diploma. Include any College, University, Trade School, or Special Training attended, along with Credit Hours Earned, Course of Study, and any Degree or Certificate Received.
  7. Licenses: If applicable, list any Licensure or Registration you hold, including the Number, Date Received, Expiration Date, and State Licensing Agency.
  8. Veteran Status: Indicate if you are a veteran or a spouse of a disabled veteran and whether you are registered for veterans’ preference.
  9. Citizenship: Answer whether you are a U.S. Citizen. If not, confirm your eligibility to work in the U.S.
  10. Certification: Read the certification statement carefully. Sign and date the application.
  11. EEO Survey: Complete the optional EEO survey at the end of the form if you choose to provide this information.

Once you have filled out the form, review it for any errors or missing information. Submit your completed application to the Office of Human Resources at the address provided. You can also fax it to the number listed. Ensure you keep a copy for your records.

Your Questions, Answered

What is the Michigan 0999D form?

The Michigan 0999D form is an employment application used by the Michigan Department of Transportation (MDOT). It is designed for individuals applying for positions within the department. While resumes are encouraged, they cannot replace the completed application form. This ensures that all candidates provide consistent and comprehensive information for review.

How do I submit the Michigan 0999D form?

To submit the Michigan 0999D form, you need to send it to the Office of Human Resources located at 934 Bridge Plaza, Sault Ste. Marie, Michigan 48783. You can also fax the completed application to (906) 635-0540. Make sure to include any required attachments, such as transcripts or additional sheets if necessary.

What information do I need to provide on the form?

The form requires a variety of personal information, including:

  1. Your name and contact information.
  2. Details about your employment history, including job titles, responsibilities, and reasons for leaving previous jobs.
  3. Your educational background, including high school and any college or trade school attended.
  4. Licenses or registrations relevant to the position, such as a CDL or CPA.
  5. Information regarding your veteran status and citizenship.

Providing accurate and thorough information is crucial, as any false statements can impact your eligibility for employment.

What if I have a disability and need assistance with the application?

If you have a disability as defined by the Michigan Persons with Disabilities Civil Rights Act, you may request reasonable accommodations to assist you in completing the application. It is important to notify the employer in writing about your need for accommodation within 182 days of when you become aware of the requirement.

What happens after I submit the form?

Once you submit the Michigan 0999D form, the Michigan Department of Transportation will review your application. They may conduct a criminal history and background check, as well as contact your previous employers for references. If your application meets their criteria, you may be invited for an interview or further assessment.

Is the information I provide confidential?

Yes, the information you provide on the Michigan 0999D form is treated with confidentiality. However, some demographic information collected for statistical purposes may be shared, but it will not affect your employment status or opportunities. Hiring managers will not have access to this information during the selection process.

Common mistakes

  1. Incomplete Personal Information: Many applicants forget to fill out all sections of the personal information part of the form. Missing details like an email address or phone number can hinder communication.

  2. Incorrect Job Titles or Dates: Some people mistakenly provide incorrect job titles or employment dates. This can lead to confusion and may raise red flags during the review process.

  3. Neglecting to Mention Previous Employment: Failing to include all relevant work experience is a common mistake. Every job, including volunteer work, can provide valuable context about your skills and background.

  4. Ignoring the Certification Section: Some applicants overlook the certification statement at the end of the form. Not signing or dating this section can result in the application being considered incomplete.

  5. Omitting Required Documentation: Transcripts and other supporting documents are often necessary. Forgetting to attach these can delay the application process or lead to disqualification.

  6. Failure to Review for Errors: Many applicants submit their forms without a final review. Typos and grammatical errors can create an impression of carelessness and may affect the overall evaluation.

Documents used along the form

The Michigan 0999D form is a crucial part of the employment application process for positions within the Michigan Department of Transportation (MDOT). Alongside this form, there are several other documents that applicants may need to submit or be aware of during their job application journey. Here’s a list of commonly used forms and documents that often accompany the Michigan 0999D form.

  • Resume: While not a substitute for the application, a resume provides a detailed overview of an applicant's work history, skills, and education. It can help showcase qualifications and experiences relevant to the job.
  • Cover Letter: A cover letter allows applicants to express their interest in the position and highlight specific experiences that make them a good fit. It adds a personal touch to the application.
  • Transcripts: For positions requiring specific educational qualifications, official transcripts from educational institutions may be needed to verify degrees and coursework completed.
  • Licensure Documentation: If applicable, documents proving the applicant holds necessary licenses or certifications (like a CDL or CPA) should be included to demonstrate eligibility for certain positions.
  • Veteran Status Documentation: Veterans may need to provide proof of service or documentation to support claims for veterans' preference in hiring.
  • Background Check Authorization: A form authorizing the employer to conduct background checks, including criminal history and employment verification, may be required as part of the application process.
  • EEO Survey: This optional survey collects demographic information for statistical purposes. It helps the agency comply with federal regulations without affecting hiring decisions.
  • Accommodations Request Form: If an applicant has a disability and needs assistance during the application process, they may need to submit a request for reasonable accommodations.

Being prepared with these documents can streamline the application process and enhance the chances of securing a position with MDOT. Ensure all information is accurate and complete to present the best possible application.

Similar forms

The Michigan 0999D form is similar to the Federal Employment Application form (Standard Form 171). Both documents serve as official applications for employment and require candidates to provide personal information, work history, and education details. The Federal Employment Application emphasizes the importance of accuracy in the information provided, similar to the Michigan 0999D, which includes a certification statement confirming the truthfulness of the information submitted. Both forms also allow for additional sheets to be attached if more space is needed to detail work experience.

Another document akin to the Michigan 0999D is the State of Michigan Employment Application (Form MDOC 0999). This form is specifically designed for positions within the Michigan Department of Corrections. Like the 0999D, it requires applicants to disclose their personal information, work history, and education. The structure of both forms is similar, ensuring that applicants provide comprehensive details about their qualifications and experiences relevant to the job they are seeking.

The Job Application Form used by the U.S. Postal Service is another comparable document. This form collects information on applicants’ work history, education, and other relevant details. Both the Postal Service application and the Michigan 0999D require applicants to affirm the accuracy of their information, underscoring the importance of honesty in the application process. Additionally, both forms allow candidates to indicate their veteran status, which can influence hiring preferences.

The Application for Employment used by the City of Detroit shares similarities with the Michigan 0999D form. Both documents require candidates to provide detailed employment history and personal information. They also include sections for applicants to disclose any previous names and to certify that the information provided is accurate. This consistency in structure helps streamline the hiring process across various departments and agencies.

The California State Employment Application is another document that mirrors the Michigan 0999D. Both forms require candidates to detail their work experience, education, and any relevant licenses or certifications. Additionally, they both include a section for applicants to indicate their veteran status and provide information on any accommodations needed due to disabilities, ensuring inclusivity in the hiring process.

Similar to the Michigan 0999D is the Application for Employment form used by the Federal Bureau of Prisons. This form collects personal information, work history, and educational background from applicants. Both documents emphasize the need for accuracy and include a certification statement to confirm that the information provided is truthful. They also allow for the attachment of additional sheets if necessary to provide a full account of qualifications.

The Application for Employment used by the Michigan Department of Health and Human Services is another comparable form. Like the Michigan 0999D, it gathers personal information, work history, and educational background. Both forms require candidates to certify the accuracy of their information and include sections for applicants to indicate their veteran status and any disabilities that may require accommodations during the application process.

The Application for State Employment in New York is similar to the Michigan 0999D in that it collects comprehensive information about applicants’ work history, education, and personal details. Both forms emphasize the importance of providing accurate information and include a certification statement to that effect. This similarity helps maintain a standard approach to employment applications across state lines.

The Application for Employment form used by the U.S. Army is another document that shares characteristics with the Michigan 0999D. Both forms require detailed information about work experience, education, and personal background. They also feature sections for candidates to disclose their veteran status and any accommodations needed for disabilities, highlighting a commitment to inclusivity and equal opportunity in hiring.

Finally, the Application for Employment used by the Michigan Department of Natural Resources is akin to the Michigan 0999D. Both forms require applicants to provide detailed personal and employment information. They emphasize the need for accuracy and include sections for disclosing any disabilities or veteran status, ensuring that all candidates have an equitable opportunity to apply for positions within the state’s departments.

Dos and Don'ts

When filling out the Michigan 0999D form, there are some important dos and don'ts to keep in mind. Here’s a helpful list:

  • Do read the entire application carefully before starting.
  • Do provide accurate and complete information.
  • Do attach any required documents, such as transcripts.
  • Do sign and date the application before submission.
  • Do submit the application to the correct address.
  • Don't leave any sections blank unless instructed.
  • Don't provide false information or exaggerate your qualifications.
  • Don't forget to include your contact information.
  • Don't ignore the instructions for veterans or those needing accommodations.

Following these guidelines can help ensure your application is processed smoothly.

Misconceptions

There are several misconceptions surrounding the Michigan 0999D form, which is used for employment applications within the Michigan Department of Transportation. Understanding these can help applicants navigate the process more effectively.

  • Resumes are a substitute for the application. Many believe that submitting a resume alone is sufficient. However, the form explicitly states that a completed application is required, and resumes are only encouraged as supplementary material.
  • Previous employment details are optional. Some applicants think they can skip providing detailed work history. In reality, the form requests a comprehensive account of past employment, including job responsibilities and reasons for leaving.
  • Disability accommodations are not available. A common misconception is that applicants with disabilities cannot receive help. The form clearly states that reasonable accommodations can be provided if requested.
  • Criminal background checks are optional. Applicants may assume that background checks are not mandatory. However, by submitting the application, individuals authorize the Michigan Department of Transportation to conduct these checks as part of the hiring process.
  • Citizenship verification is not important. Some may think that citizenship status is irrelevant. The form specifically asks about U.S. citizenship and eligibility to work in the U.S., highlighting its significance in the application process.
  • Information provided will affect hiring decisions. There is a belief that the demographic information requested is used in the selection process. However, the form clarifies that this data is for statistical purposes only and will not influence employment opportunities.

Key takeaways

Here are some key takeaways about filling out and using the Michigan 0999D form:

  • Complete All Sections: Make sure to fill out every section of the application. Incomplete applications may not be considered.
  • Provide Accurate Information: Ensure that all details, including employment history and personal information, are correct. Any false statements can lead to disqualification.
  • Submit Required Documents: Along with the application, attach any necessary documents, such as transcripts or resumes, to support your qualifications.
  • Follow Submission Guidelines: Send your completed application to the specified address or fax number. Adhere to any deadlines mentioned in the job posting.