SCHOOL BUS DRIVER APPLICATION SOUTHERN DOOR COUNTY SCHOOL DISTRICT 2073 County DK, Brussels, WI 54204 Telephone: 920/825-7311 Fax: 920/825-7155 NAME_____________________________________________MI________ DATE PHONE #____________________________E-Mail____________________________________________ ADDRESS Street City State Zip Are you interested in substitute work? If yes, when are you available? Do you possess a current CDL license with bus driving rider? License #________________________________ State Do you have or have you had any disease, disorder, or impairment (such as a heart condition, high blood pressure, diabetes, epilepsy, etc.) which would likely interfere with your ability to safely drive or be licensed to drive a school bus? If yes, explain Have you been convicted of any of the offenses listed below in the past five years? A yes answer does not automatically exclude you as a candidate. Yes No [ ] [ ] Reckless driving. [ ] [ ] Homicide resulting from the operation of a motor vehicle. [ ] [ ] Operation of a motor vehicle while under the influence of intoxicants or drugs. [ ] [ ] Failure to stop and render aid in the event of an accident. [ ] [ ] Perjury or making a false statement relating to operation or ownership of a motor vehicle. [ ] [ ] Operating a motor vehicle while operating privileges are suspended or revoked. [ ] [ ] Operating a motor vehicle without furnishing proof of financial responsibility. [ ] [ ] Violation, restriction or serious traffic violation by holders of occupational licenses. [ ] [ ] Any felony. [ ] [ ] Any offense against public morals. If any are yes, explain Have you been involved in a motor vehicle accident in the past three years? If yes, explain Record of Employment (list last three positions held) Position
Position
Employer
Employer
City/State
City/State
Reason for Leaving
Reason for Leaving
Position
Position
Employer
Employer
City/State
City/State
Reason for Leaving
Reason for Leaving
EDUCATION High School Colleges Major/s Minor/s Degrees Held
GPA GPA # of Credits # of Credits Year Received
Why are you interested in this position?
Why do you think you would be a good school bus driver?
List three persons to whom we may refer to both your personal and occupational qualifications Name Address Telephone Position _________________ _________________ __________ _________________ _________________ __________ _________________ _________________ __________ Are you available mornings until 8:30 A.M. and afternoons after 2:00 P.M.? If selected for this position, when could you begin work? My signature below certifies that all statements made on this application are true and complete to the best of my knowledge. If employed by this school district, I understand that any misrepresentation of factual information contained herein may be cause for dismissal. Signature As per Federal and State Laws, the Southern Door County School District does not discriminate in employment on the basis of age, race, color, religion, national origin, sex, handicap, creed, marital status, ancestry, arrest or conviction record, or sexual orientation. It is this employer's policy to make reasonable accommodations for persons with disabilities in the hiring process. If your disability prevents you from reading or filling out this application form, please let us know and we will provide assistance. May we contact your current employer and all previous employers and references you have listed? _____ yes
_____ no
Exceptions____________________________________________________________________.
