Bus Driver APPLICATION FORM

Name

First NameLast Name

Birthdate

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Cellphone Number

Please enter a valid phone number.

Email

example@example.com

For what position are you applying?

Date of Application

Date

Do you hold a current Commercial Driver's License with an "S" endorsement?

If yes, list number and expiration date.

Do you hold a current Defensive Driving Card? (If Yes, please list the expiration date.)

Do you hold a current First Aid/CPR Card? (If Yes, please list the expiration date.)

NOTE - Upon application of any person seeking to become a school bus driver, the prospective employer shall inspect the applicant's driving record through the Division of Vehicles, Kansas Department of Revenue, in accordance with K.S.A. 74-2012 as amended by 1. 1984, Ch. 282, Sec. 1.

Any employer of school bus drivers shall not employ, re-employ or retain any person as a school bus driver if the person’s driving record indicates that the person is a habitually reckless or negligent driver of a motor vehicle. A habitually reckless or negligent driver shall be a person who has had a driver’s license revoked or suspended by the Division of Vehicles, Kansas Department of Revenue, pursuant to K.S.A. 1983 Suppl.

High School and Year of Graduation

College/Technical School: blanks Location: blank

Dates: blanksto blank .

Degree/Hours: blanksMajor Fieldblank .

College/Technical School: blanks Location: blank

Dates: blanksto blank .

Degree/Hours: blanksMajor Fieldblank .

College/Technical School: blanks Location: blank

Dates: blanksto blank .

Degree/Hours: blanksMajor Fieldblank .

College/Technical School: blanks Location: blank

Dates: blanksto blank .

Degree/Hours: blanksMajor Fieldblank .

Current Employer

Exact type of certificate/license (if applicable)

Date of Expiration

Date

Your reason for wanting to become a school bus driver:

Chronological Education Employment

Other Work Experience

List three professional or employer references:

Is it permissible to contact the above references?

If no, what date will contacts be permissible?

Physical limitations, if any?

Applicant Job Application Acknowledgements

I certify that all the information provided by me in this application is true and complete. I understand that any misstatement, falsification, or omission of information is grounds for a refusal to hire or if I am hired and the same is discovered thereafter termination.

I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability for any damages that may result from furnishing such information to you. I authorize any background checks by any third party.

I authorize you to request, receive, and verify all information given on this application and I release you from all damages that may result from your doing so.

I authorize you to conduct a criminal background investigation using any and all methods necessary to successfully complete such investigation, and I release you from all liability for any damages that may result from your doing so.

Signature

Date

Notice of Non Discrimination

Applicants for admission and employment, students, parents of elementary school students, employees, source of

referral of application for admission and employment, and all unions or professional organizations holding collective bargaining on the basis of race, color, national origin, sex, age or handicap in admission or access to, or treatment or employment in its programs and activities. Any person having inquiries concerning Unified School District #430 compliance with the regulations implementing Title VI, Title IX, or Section 504 is directed to contact the
Superintendent, 522 Central Avenue, Horton, Kansas 66439, 785-486-2611. The Superintendent has been designated by Unified School District #430 to coordinate the institution’s efforts to comply with the regulations implementing Title VI, Title IX and Section 504. Any person may also contact the Assistant Secretary of Civil Right,
U.S. Department of Education, regarding the institution’s compliance with the regulations implementing Title VI,
Title IX, or Section 504.

Bus Driver Application

Educational Data

Professional Data