Name *

First Name

Last Name

Phone

(###)

###

####

If offered employment, can you submit verification of your legal right to work in the U.S.? *

Yes

No

Are you willing to take training courses for bus drivers and attend periodic safety meetings? *

Yes

No

If you did not graduate from High School, have you received your GED?

yes

No

Have you held a license in another state?

Yes

No

Have you ever been convicted of violating any traffic laws?

Yes

No

Has your license ever been suspended?

Yes

No

PERSONAL INFORMATION: Have you ever been convicted or received probation before judgment for a crime?

Yes

No

PERSONAL INFORMATION: Have you been charged with a crime and/or are awaiting trial?

Yes

No

PERSONAL INFORMATION: ave you ever been dismissed, asked to resign or refused employment?

Yes

No

PERSONAL INFORMATION: Have you ever been investigated or charged with any offense relating to children?

Yes

No

PERSONAL INFORMATION: Have you ever received an oral or written reprimand from a previous employer?

Yes

No

PERSONAL INFORMATION: Have you ever tested positive on a drug/alcohol test?

Yes

No

PERSONAL INFORMATION: Have you ever refused to take a drug/alcohol test?

Yes

No

PERSONAL INFORMATION: If fingerprinted, would you pass a Federal and State background check?

Yes

No

PERSONAL INFORMATION: In previous employment have you been on a drug /alcohol testing program?

Yes

No

PLEASE READ CAREFULLY: I understand to drive a school bus for a Bus Contractor transporting Public School students I am required: PLEASE CHECK IF YOU AGREE. *

To pass a Department of Transportation (DOT) Physical as part of the pre-employment process and annually. I understand and grant permission for the Employer/Hiring Personnel and the Designee for the Public School System to view my DOT Physical forms.

To pass a pre-employment drug screening with a negative result. As well, I understand and agree to be placed on a safe sensitive Drug Program. I understand I can/will be drug/alcohol screened; randomly pulled, for reason of suspicion and post-accident

To be fingerprinted and subject to a criminal background check, state and federal as part of the pre- employment process. I understand that my criminal records will be monitored through the school system for the duration of employment. I understand that I am required to immediately report any charges made towards me.

I understand that my Driving record must meet the following requirements:  No more than two (2) current points and/or have been assessed within the past five (5) years  No more than four (4) points have been assessed within the past ten (10) years  No more than one (1) “failure to appear” entry assessed within the past five (5) years  No drug or alcohol related point assessment  Are also monitored through the school system during the duration of employment. I understand that I am required to immediately report and violations made towards me. *

I AGREE

I DISAGREE

LIE DETECTOR TESTS: (Article 100, Section 95, Annotated Code of Maryland) “Under Maryland law an employer may not require or demand any applicant for employment or prospective employment or any employee to submit to or take a polygraph, lie detector or similar test or examination as a condition of employment or continued employment. Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100.”

I AGREE

I DISAGREE

I understand that acceptance of this application does not constitute an employment agreement. I hereby affirm that the information given by me in this application is true and complete to the best of my knowledge and belief. I understand that any misrepresentation will be sufficient cause for discharge. The Employer has my permission to contact all past or present Employers and personal references. *

By Checking YES, YOU DO AGREE to all information and is considered your electronic signature.

By Checking NO, YOU DO NOT AGREE to all information and is considered your electronic signature