| DATE: |
Last Name |
First Name |
Middle Name |
Maiden Name |
| Present Address:(Street OR P.O. Box) |
City |
State |
Zip Code |
Birthday |
Telephone # |
| Name as it Appears on Social Security Card: | |
| Years of Driving Experience (Specify): Car | Bus | Truck |
| Driver's License Number: | Class | EXP |
| Have you been involved as a driver in traffic accidents in the last 3 years? Yes No |
| If Yes, Date | Nature of Accident |
| Fatalities | Injuries |
| Have you been convicted of any traffic violations? Yes No |
| If Yes, Location (City & State) | Charge | Penalty |
| Date |
| Has your license, permit or privilege ever been suspended or revoked? Yes No (If so, explain with an attachment) |
| Circle the Highest Grade Completed | 1
2
3
4
5
6
7
8
9
10
11
12 | College
1
2
3
4 |
| Have you ever been convicted of a Felony? Yes No |
| Explain |
| Safe Driving Award you hold and from whom? |
| Are you willing to attend a bus driver training course? Yes No |
| Past Employment:(Start present position) May we contact them? Yes No |
| Name: | Phone #: |
| Position: | Address: |
| Name: | Phone #: |
| Position: | Address: |
| Reference:(Persons not related to you but who have knowledge of your qualifications for the position for which you are applying) |
| Name: | Phone #: |
| Position: | Address: |
| Name: | Phone #: |
| Position: | Address: |
| I understand that any false answer or statement or implication made by me on this application shall be considered sufficient cause for denial of employment. This certifies that this application was completed by me (or under my direction), and that all entries and information are true and complete to the best of my knowledge. |
| Signature | Date |
THE TOOMBS COUNTY BOARD OF EDUCATION IS AN EQUAL OPPORTUNITY EMPLOYER. THE BOARD DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, SEX, AGE, NATIONAL ORIGIN OR HANDICAP IN ITS EDUCATIONAL PROGRAMS, ACTIVIES, OR EMPLOYMENT POLICIES. |