Instructor - Driver Training

Application for Employment
SafeWay Location*
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If you are interested in this location, please click here to proceed.

APPLICANT INFORMATION

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Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Cell Phone*

Area CodePhone Number
Home Phone

Area CodePhone Number
Date Available

MonthDayYear
Driver's License #*
Issuing State*
TEA License #
Certification Level
Citizenship*
Country of Citizenship
Please specify the country of your Citizenship
Work Authorization
Are you authorized to work in the U.S.?
Crime History*
Have you ever been convicted of a felony?
Explaination
If you've been convicted of a felony, please explain
Prior Employment with SafeWay
Have you ever worked for SafeWay?
When?
Drug Test*
If selected, are you willing to submit to a drug test?

EDUCATION

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Please enter your education experience (starting from high school) in chronological order.

Education Experience #1
School Name
School Type
School Address
Attended From

MonthDayYear
Attended To

MonthDayYear
Did You Graduate?
Degree/Diploma
What degree/diploma did you receive?
More Experience?
Do you want to add more education experience?

Education Experience #2
School Name
School Type
School Address
Attended From

MonthDayYear
Attended To

MonthDayYear
Did You Graduate?
Degree/Diploma
What degree/diploma did you receive?
More Experience?
Do you want to add more education experience?

Education Experience #3
School Name
School Type
School Address
Attended From

MonthDayYear
Attended To

MonthDayYear
Did You Graduate?
Degree/Diploma
What degree/diploma did you receive?
More Experience?
Do you want to add more education experience?

Education Experience #4
School Name
School Type
School Address
Attended From

MonthDayYear
Attended To

MonthDayYear
Did You Graduate?
Degree/Diploma
What degree/diploma did you receive?
More Experience?
Do you want to add more education experience?

Education Experience #5
School Name
School Type
School Address
Attended From

MonthDayYear
Attended To

MonthDayYear
Did You Graduate?
Degree/Diploma
What degree/diploma did you receive?

PREVIOUS EMPLOYMENT

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Previously Employed?
Were you previously employed?
Please list 3 recent employments here. Enter the most recent employment first.

INSTRUCTOR APPLICANT CRITERIA

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An instructor candidate must meet the following criteria in order to be considered for training and licensing as a driver instructor in the state of Texas and to begin the SafeWay training program. A criminal background check will be run on each applicant. Please check only the criteria you meet.

Good Reputation – a person is considered to be of good reputation if: (Check each box indicating you meet these criteria)*

	Check
I have no felony convictions (or can successfully demonstrate that I have been rehabilitated).
I have no convictions involving crimes of moral turpitude (conduct that is inherently immoral or dishonest).
Within the last 7 years, I have not been successfully sued for fraud or deceptive trade practice.
I have no misdemeanor or felony convictions for driving while intoxicated over the past 7 years.

High School Graduate*

Check

I have a high school diploma (list info in Education section).

Driving Record*

	Check
I presently have held a drivers license for the past 5 years with no driver license suspensions, have not had my license forfeited or revoked in the past 5 years for traffic-related violations.
I currently have less than 6 penalty points on my driving record during the last 36 months. (Penalty points are for traffic tickets).
I will order my motor vehicle record (MVR) and bring it to my interview. (https://www.texasonline.state.tx.us/tolapp/txldrcdr/TXDPSLicenseeManager)

SafeWay is a SMOKE-FREE workplace. No smoking is allowed on the premises, in the car or anywhere around students.

REFERENCES

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Please list three professional references.

Reference #1
Full Name

First NameLast Name
Relationship
Company
Phone

Area CodePhone Number
Address

Reference #2
Full Name

First NameLast Name
Relationship
Company
Phone

Area CodePhone Number
Address

Reference #3
Full Name

First NameLast Name
Relationship
Company
Phone

Area CodePhone Number
Address

ACKNOWLEDGEMENT AND AUTHORIZATION

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I agree*

	Agree
I certify that my answers are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature*

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