Michigan Form 0999D – Fill Out and Use This PDF

The Michigan 0999D form, issued by the Michigan Department of Transportation, serves as an essential employment application document. This form is designed to ensure equal opportunity for all applicants and is not substitutable by resumes, though they are encouraged to be included alongside the application. For individuals aiming to be a part of the Michigan Department of Transportation, completing and submitting this form to the specified address is the first step towards potential employment.

To begin the process of applying for a position with the Michigan Department of Transportation, click the button below to fill out the Michigan 0999D form.

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Michigan Form 0999D PDF Details

The Michigan Department of Transportation (MDOT) Employment Application, designated as form 0999D, is a structured document that serves as a gateway for individuals seeking employment within the department. This form, updated as of January 2007, underscores the state’s commitment to equal employment opportunities, clearly stating that while resumes can supplement the application, they cannot replace it. Applicants are advised to direct their applications to the Office of Human Resources in Sault Ste. Marie, with provisions made for fax submissions. The form requires applicants to detail their prospective position, personal information, educational background, any special licenses or registrations, veteran status, and citizenship information. It also includes a section for a detailed employment history, asking for in-depth descriptions of responsibilities and experiences across previous roles. The necessity of honesty and the provision of accurate information are heavily emphasized, with applicants required to certify their submissions under the risk of disqualification for employment or termination if inaccuracies are discovered post-hire. Additionally, the form includes a voluntary Equal Employment Opportunity Survey, designed to gather demographic data in compliance with Federal Highway Administration requirements, though it assures applicants that this information will not influence the hiring process. This comprehensive approach to gathering applicant data reflects MDOT’s efforts to facilitate a thorough and fair evaluation process for all candidates.

Question	Answer
Form Name	Michigan Form 0999D
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	mdot_som_employ ment_applicatio n_0999D_318166_ 7 mdot driver employment application form

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of Transportation	EMPLOYMENT APPLICATION	Page 1 of 3
Michigan Department		Page 1 of 3
0999D (01/07)	Equal Opportunity Employer
0999D (01/07)

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

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

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:	MALE	FEMALE
____
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.



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Completing this form will require thoroughness. Make certain all necessary areas are filled in accurately.

1. To begin with, when completing the Michigan Form 0999D, start with the form section that contains the following fields:

Michigan Form 0999D writing process shown (portion 1)

2. The subsequent stage is usually to complete the following blank fields: CREDIT HOURS EARNED QTR SEM, RECEIVED, TRADE SCHOOLSPECIAL TRAINING, TRADE SCHOOLSPECIAL TRAINING, YOUR NAME IF DIFFERENT WHILE, LICENSURE OR REGISTRATION, NUMBER, DATE RECEIVED EXPIRATION DATE, VETERAN Are you a veteran, Yes, Yes, Yes, and Yes.

How to prepare Michigan Form 0999D part 2

3. Through this stage, take a look at MDOT D PERIODS OF EMPLOYMENT, Address Phone No, Your Job Title Supervisors Name, FROM TO MONTH DAY YEAR MONTH DAY, HOURS PER WEEK YOUR NAME IF, Duties and Responsibilities, Reason for Leaving, Name of Present or Last Employer, Address Phone No, Your Job Title Supervisors Name, FROM TO MONTH DAY YEAR MONTH DAY, HOURS PER WEEK YOUR NAME IF, and Duties and Responsibilities. Each one of these will have to be filled in with highest precision.

Michigan Form 0999D conclusion process explained (portion 3)

You can certainly get it wrong while filling in your Duties and Responsibilities, so you'll want to look again prior to when you send it in.

4. The form's fourth subsection comes with all of the following empty form fields to fill out: Duties and Responsibilities, Reason for Leaving, Name of Present or Last Employer, Address Phone No, Your Job Title Supervisors Name, FROM TO MONTH DAY YEAR MONTH DAY, HOURS PER WEEK YOUR NAME IF, Duties and Responsibilities, Reason for Leaving, and CERTIFICATION I certify that all.

A way to fill out Michigan Form 0999D stage 4

5. And finally, the following last part is precisely what you should wrap up before using the document. The blanks at this stage include the following: CERTIFICATION I certify that all.

Michigan Form 0999D writing process described (stage 5)

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Michigan Form 0999D – Fill Out and Use This PDF

Michigan Form 0999D PDF Details

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