APPLICATION FOR EMPLOYMENT

This Application for Employment is being made to Todd Transit, Inc. All applications are kept on file for a minimum of 30 days, held at the company headquarters at 1355 Capital Dr., Rockford, IL. Applications may be faxed to 815-***-**** or scanned/emailed to ad0u30@r.postjobfree.com. In compliance with Federal and State equal employment opportunity laws, qualified applicants will be considered for all positions without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status. Applicant's Printed Name Date of Application

To Be Read and Signed By Applicant

I authorize you to make such investigations and inquiries of my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons or entities from all liability in responding to inquiries and releasing information in connection with my application to Todd Transit, Inc. 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, regulations, and policies set forth by Todd Transit, Inc if I accept a position within said company, I also understand that submitting an application that is incomplete will not qualify me for employment with Todd Transit, Inc. Todd Transit maintains a list of minimum hiring standards which I understand I must continue to meet those qualifications after employment, and if I fall outside of those minimum requirements, I will no longer be qualified for employment with Todd Transit, Inc.

I understand that information I provide regarding current and/or previous employers may be used and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

Review information provided by previous employers;

Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and

Have a rebuttal statement attached to the alleged erroneous information if the previous employer(s} and I cannot agree on the accuracy of the information.

Applicant's Signature Date

Applicant to Complete

(Answer All Questions Completely- Please Type or Write Neatly) Position(s) Applied for Cell Phone Number

Email Address Home Phone Number

Name (Last) (First) (Middle) Social Security Number Date of Birth (Required for CDL Drivers) Driver's License Number State of Issue Class Endorsements Restrictions Emergency Contact Name & Relationship Phone Number List your addresses of residency for the past 3 years. Current Address City State Zip Code How Long?

Previous Address City State Zip Code How Long?

Previous Address City State Zip Code How Long?

Previous Address City State Zip Code How Long?

Do you have the legal right to work in the United States? Yes No Are you employed now? Yes No If No, how long since leaving last employment? Have you ever been convicted of a felony? Yes No If Yes, please explain on a separate sheet of paper (conviction of a crime is not an automatic bar to employment. All circumstances will be considered). Have you ever worked for Todd Transit before? Yes No If Yes, Where? Dates - From: To: Rate of Pay: __ Position: Rate of Pay Expected:

Preference of hours:

Is there any reason you might be unable to perform the functions of the job for which you have applied? Yes No Education

Highest Grade Completed: 1 2 3 4 5 6 7 8 High School: 1 2 3 4 College: 1 2 3 4 Degree: __ Last School Attended: _ _

Name of School City

State

List any other training or education pertinent to this position: 2

3

Safety History

Accident Record for Past 3 Years.(Attach sheet if more space is needed) If none write "none" Traffic Convictions and Forfeitures for the Past 5 Years. [Other than Parking Violations. Attach sheet if more space is needed) If none write "none" lLocation Date Charge Penalty

Driver’s licenses: (list all driver’s licenses held in the past 3 years) State of issuance License number Type Expiration/forfeiture date Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes No Has your license, permit, or privilege ever been suspended or revoked for ANY reason? Yes No If Yes, please explain why:

Driving Experience

Class of Equipment

Yes/No

(Type or Write in All That Apply)

28’ 40’48’ 53’ Van, Refer, Dump, Tank. Flat. Dry Bulk. Rail Con To

(Mo/Yr)

From

(Mo/Yr)

Approx.

Number Miles

Straight Truck

Tractor Trailer

Tractor Twin Trailers

Tractor Triple Trailers

Motor coach

School Bus

Other

List any safe driving awards, and who you hold them from: List all states operated in for the last 5 years: List any experience, qualifications, training or skill that may help you in this job: Date Nature of Accident Towed away? Fatalities? Injuries? Hazmat Spill? Last

Accident

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Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 10 years.

**The Federal Motor Carrier Safety Regulations apply to anyone operating a motor vehicles on a highway in interstate commerce to transport passengers or property when the vehicle: ( 1) a GVWR of 10,001 lbs. or more. (2) is designed or used to transport more than 8 passengers

(including the driver),or (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding. List Employers in reverse order, starting with the most recent. (Must Complete All information below. (Add another Sheet if necessary) Dates

Employer Name From Mo/Yr I To Mo/Yr

Address I

City I State I Zip Position Held

Supervisor I Phone Wage/Salary

Were you subject to the FMCSRs •• While Employed? Yes No Reason for leaving Was your job designated as a Safety-Sensitive Function in any DOT-Regulated mode subject to Drug and Alcohol Testing requirements of 49 CFR Part 40? Yes No

Dates

Employer Name From Mo/Yr I To Mo/Yr

Address I

City I State I Zip Position Held

Supervisor I Phone Wage/Salary

Were you subject to the FMCSRs •• While Employed? Yes No Reason for leaving Was your job designated as a Safety-Sensitive Function in any DOT-Regulated mode subject to Drug and Alcohol Testing requirements of 49 CFR Part 40? Yes No

Dates

Employer Name From Mo/Yr I To Mo/Yr

Address I

City I State I Zip Position Held

Supervisor I Phone Wage/Salary

Were you subject to the FMCSRs •• While Employed? Yes No Reason for leaving Was your job designated as a Safety-Sensitive Function in any DOT-Regulated mode subject to Drug and Alcohol Testing requirements of 49 CFR Part 40? Yes No

Dates

Employer Name From Mo/Yr I To Mo/Yr

Address I

City I State I Zip Position Held

Supervisor I Phone Wage/Salary

Were you subject to the FMCSRs •• While Employed? Yes No Reason for leaving Was your job designated as a Safety-Sensitive Function in any DOT-Regulated mode subject to Drug and Alcohol Testing requirements of 49 CFR Part 40? Yes No

To Be Read and Signed By the Applicant

This certifies that I completed this application. and that all entries and information contained in it are true and complete to the best of my knowledge. Applicant's Signature Applicant's Printed Name Date

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