Instructor - Driver Training

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

APPLICANT INFORMATION

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Full Name *

First Name Last Name
Date of Birth *

Month Day Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
Cell Phone *

Area Code Phone Number
Home Phone

Area Code Phone Number
Date Available

Month Day Year
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

Month Day Year
Attended To

Month Day Year
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

Month Day Year
Attended To

Month Day Year
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

Month Day Year
Attended To

Month Day Year
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

Month Day Year
Attended To

Month Day Year
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

Month Day Year
Attended To

Month Day Year
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.

Previous Employment #1 (most recent)
Employer Name
Phone Number

Area Code Phone Number
Address
Supervisor
Job Title
Pay Rate
Responsibilities
Start Date

Month Day Year
End Date

Month Day Year
Reason for Leaving
Reference
May we contact this employer for a reference?
More Employment?
Do you want to add more employment record?

Previous Employment #2
Employer Name
Phone Number

Area Code Phone Number
Address
Supervisor
Job Title
Pay Rate
Responsibilities
Start Date

Month Day Year
End Date

Month Day Year
Reason for Leaving
Reference
May we contact this employer for a reference?
More Employment?
Do you want to add more employment record?

Previous Employment #3
Employer Name
Phone Number

Area Code Phone Number
Address
Supervisor
Job Title
Pay Rate
Responsibilities
Start Date

Month Day Year
End Date

Month Day Year
Reason for Leaving
Reference
May we contact this employer for a reference?

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 Name Last Name
Relationship
Company
Phone

Area Code Phone Number
Address

Reference #2
Full Name

First Name Last Name
Relationship
Company
Phone

Area Code Phone Number
Address

Reference #3
Full Name

First Name Last Name
Relationship
Company
Phone

Area Code Phone 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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