DATE

1 LOCOMOTIVE ENGINEER. 180 Boyden Ave., Maplewood, NJ 07040-2494. MONTH DAY YEAR. FIELDS IN RED ARE MANDATORY. DATE / /. PERSONAL DATA. NAME (Last) SOCIAL SECURITY NUMBER. - - NAME (First) MI. Do Not Use A. Box ADDRESS (Number) (Street) (Apartment Number / Suite). CITY STATE ZIP CODE. FULL E-MAIL ADDRESS. SECONDARY PHONE NO. P R I M A R Y PHONE NO. - - - - If hired, you will be required to furnish proof that you are legally authorized to work in the United States. Are you legally able to work in the United States? Yes No Have you ever been employed by NJ Transit? Yes No Position Held: W hen: Do you have any relatives working for NJ Transit? Yes No If YES, PLEASE COMPLETE THIS SECTION. NAME: RELATIONSHIP: JOB TITLE: LOCATION: RELATIVES WILL NOT BE EMPLOYED UNDER DIRECT SUPERVISION OF ONE ANOTHER NOR WILL THEY BE PLACED IN THE.

2 SAME DEPARTMENT IF, IN NJ TRANSIT'S OPINION, THIS COULD RESULT IN POTENTIAL CONFLICTS OF INTEREST. EDUCATIONAL RECORD. HAVE YOU Diploma/Degree Field of Name, Street, City and State of School COMPLETED or Credits Earned Study High School YES NAME. or ADDRESS. GED NO. NAME. YES. College ADDRESS. NO. NAME. College YES. ADDRESS. NO. NAME. Professional or YES. Technical NO. ADDRESS. Schools NAME. YES. Graduate ADDRESS. NO. NEW JERSEY TRANSIT IS AN EQUAL OPPORTUNITY EMPLOYER Draft PAGE 1/4. EEMv020515. _LETP. ARE YOU WILLING TO WORK? ( Fill in all that apply) Full-time Part-time Evenings Weekends DATE AVAILABLE. / /. SKILLS & (Please indicate each position that you are applying for by filling in the appropriate circle next to that position.). EXPERIENCES SKILLS & EXPERIENCES. 001 - PT - Bus Operator 201 - Ticket Vending Machine Maintainer 312 - Accounting / Finance (Please indicate each skill and experience by filling in the appropriate circle next to that 002 - PT - Ticket Agent skill or experience.)

3 202 - Laborer 313 - Nurse 003 - PT - Transit Information Clerk 203 - CAM (Rail Car Cleaner) 314 - Medical Technician o S101 MS Access o E201 Electrical Industrial/Residential 101 - Machinist 204 - Bus Cleaner 315 - Public Relations o S113 MS Office o E202 Electronics 102 - Mechanic 205 - Car Inspector (Train) 316 - Paralegal 103 o S114. - Pipefitter MS Excel 206 - Assistant Conductor HVAC. o E203 401 - Supervisor - Maintenance 104 o Service Person - BusS115 MS Project 207 - Locomotive Engineer o Plumbing E204 402. 406 - Doctor - Supervisor - Operations 105 o - BusS116 MS. Mechanic Word 301 - Clerical Machine o E205 501. 405. - Engineer Operator - Human Resources o S117 MS Power Point 106 - Electrician 302 - Administrative/Secretarial o E206 Customer Service 107 - Electronic Technician o S118 WordPerfect Software 306 - Marketing/Market Research o E208 Bus/Heavy Equipment Driver 108 - Signal/Comm.

4 Maintainer 308 - Customer Service Rep 603 - Architect / Draftsperson o S191 OTHER Database Software o E209 Truck Driver 109 - Welder 309 - Police Officer 602 - Information Systems o S192 OTHER Operating Systems o E210 Auto Mechanic 110 - Boiler Operator 310 - Fare Inspector 999 - OTHER. o S194 OTHER Programming o E211 Bus Mechanic ce 111 - Custodial / Janitorial 311 - Dispatcher o S193. After filling more in one or OTHER Software jobs/positions o E212 Diesel/ Heavy Equipment Mechanic above that you are interested in, pick your first choice and insert the three digit number next to the job position into the Choice #1 box. Repeat for your second and third choi s. o S111 AutoCAD o E213 Supervisory Choice #1 Choice #2 Choice #3. o S105 Oracle o E214 Clerical o S103 JAVA o E216 Administrative/ Clerical S101 - MS Access S121 - Basic E208 - Bus/Heavy Equipment Driver o S102 Sybase/C++ o E217 Project Manager S113 - MS Office S122 - Cobol E209 - Truck Driver S114o- MS Excel Basic S121 S123 - SQL.

5 (H. o E218 E210. Medical - Auto Mechanic S115o- MS . Project S122 Cobol S124 - Visual Basic o E219 E211. Operations - Bus Mechanic S116 - MS Word o S123 SQL. S125 - Hyper Text Markup Language E220 E212. o TML) - Diesel/Heavy Equipment Legal/ Paralegal Mechanic S117 - MS Power Point S131 - MS Windows Operating Systems S126 E213 - Supervisory S124 Visual o E221 Typing Speed _____ WPM. S118o- WordPerfect SoftwareBasic - Adabas Natural E214 - Clerical S191o- OTHER HyperSoftware S125 Database Text Markup S132 Language - Unix OS (HTML) o E207 E216. Stenography _____ WPM. - Administrative/Secretarial S192 - OTHER Operating Systems S136 - MVS OS. o S131 MS Windows Operating Systems o E291 E217 - Project_____. OTHER Manager E201 - Electrical Industrial/Residential E218 - Medical 1o- S132 Unix OS E202 - Electronics E219 - Operations 5o- S136 MVS OS E203 - HVAC E220 - Legal/Paralegal E204 - Plumbing E221 - Typing Speed WPM.

6 S103 - JAVA. What E205 - Machine Operator led you to apply to NJ TRANSIT? Ad Agency E207 - Job Stenography Fair Walk-in WPM. S102 - Sybase/C++ E206 - Customer Service Employee Internet E291 - Other OTHER. Please What led youspecify the to apply to NJ Ad, Agency, Transit? Ad Job Fair, Walk-in, Agency Employee, School Internet, Walk-in Other:_____. Employee Internet Other Please specify the Ad, Agency, School, W alk-in, Employee, Internet, Other: Draft EEMv020515 PAGE 2/4. LETP. APPLICANT HISTORY. PLEASE COMPLETE FOR THE PAST SEVEN YEARS, STARTING WITH CURRENT OR MOST RECENT EMPLOYMENT. PLEASE. USE ADDITIONAL SHEETS IF NECESSARY. MONTH YEAR. CURRENT OR MOST FROM DATE /. RECENT TO DATE /. Employer's Name Employer's Address Work Hours Employer's City State Zip Code Job Title Name Under Which Employed Job Duties and Responsibilities Supervisor's Name Supervisor's Title Supervisor's Phone No.

7 Reason For Leaving MONTH YEAR. DATES FROM DATE /. TO DATE /. Employer's Name Employer's Address Work Hours Employer's City State Zip Code Job Title Name Under Which Employed Job Duties and Responsibilities_____. Supervisor's Name Supervisor's Title Supervisor's Phone No. Reason For Leaving MONTH YEAR. DATES FROM DATE /. TO DATE /. Employer's Name Employer's Address Work Hours Employer's City State Zip Code Job Title Name Under Which Employed Job Duties and Responsibilities Supervisor's Name Supervisor's Title Supervisor's Phone No. Reason For Leaving MONTH YEAR. DATES FROM DATE /. TO DATE /. Employer's Name Employer's Address Work Hours Employer's City State Zip Code Job Title Name Under Which Employed Job Duties and Responsibilities Supervisor's Name Supervisor's Title Supervisor's Phone No. Reason For Leaving Draft PAGE 3/4.

8 EEMv020515. LETP. ALL SECTIONS MUST BE COMPLETED TO BE CONSIDERED FOR EMPLOYMENT. LICENSE INFORMATION. DRIVER'S LICENSE NO. STATE CLASS ENDORSEMENTS. License Restrictions Yes No If Expiration Date: _____. Yes, list restrictions here MONTH YEAR MONTH YEAR. No If yes, when? From: To: Ever been Suspended/Revoked? License Yes Currently Suspended or Revoked? Yes No - - ason: Doyou Do you have have any anyDriving DrivingOffenses and/or Offenses Convictions and/or for DUI/DWI. Convictions within the last 12 months? for DUI/DWI. YesYes No within the last 12 months? No IfIfYES, YES,list listbelow them below: ALL pending violations and ALL convictions for traffic violations (except parking) in the last (3). years. All applicants will be thoroughly investigated. Therefore, any omission or willful mis-statement will be cause DATE OF DATE OF DISPOSITION.

9 VIOLATION OFFENSE CONVICTION AND FINE NAME OF COURT AND LOCATION STATUS OF ANY PENDING MATTER. (mm/yyyy) (mm/yyyy). 1. 2. 3. CRIMINAL RECORD INFORMATION. Do you have any criminal court action pending against you OR have you ever been convicted (found guilty) of any crime or offense APPLICANT'S. (misdemeanor and/or felony) in any state or CERTIFICATION, elsewhere? Yes& AUTHORIZATION. AGREEMENT No If YES give details below. DATE OF OFFENSE OFFENSE NAME OF COURT AND LOCATION DISPOSITION / STATUS. 1. I hereby certify that the foregoing statements are true, complete and correct to the best of my knowledge and belief and are made in 2 good faith. I understand that if I provide any misleading or incorrect information during the employment process it may render this 3 application void and result in my immediate termination if the misleading or incorrect nature of the information is discovered if and after I am employed.

10 In your ownI hereby words authorize my former explain each crime oremployers offense. to release anyspace If additional information theyuse is needed mayanother have concerning my employment sheet of paper. with them and hereby release NJ TRANSIT (hereinafter the Company ) and all previous employers listed above from all liability 1 whatsoever that may ensue from providing or securing this information. I further authorize representatives of the Company to take all 2 reasonable actions to verify any and all information contained herein and to obtain and review any and all driving and disciplinary 3. records of any sort that may exist concerning me. If the Company employs me, I agree to conform to the rules and regulations of the Company. I understand that if I am employed in a position not covered by a labor agreement, my employment will be at will , and that my employment can be terminated at APPLICANT'S.