Bus Driver Application (Form)

Bus Driver Application (From)

EMPLOYMENT APPLICATION ADDENDUM FOR SCHOOL BUS DREVERS
Used for personnel who are required to have a CDL.

Karnack Independent School District
PO Box 250, 655 Fason Street
Karnack, Texas 75661
Phone 903-679-3117   Fax 903-679-4252
An Equal Opportunity Employer*

Date of application 


Personal Data

Last Name   First Name   Middle Initial 

Phone Number 

Email address 

Hours available for work 

Driver's Licenses Number   Type 

Have you ever had a driver's license suspended, revolked, or cancelled?  Yes  No

If you answered yes, explain 


Background Check Information

Are there any criminal harges or proceedings pending againstt you? Yes  No

If you answered yes, explain 

In the past 10 years, have you:

(1) been conviced of or received deferred adjudication, probation, r other adjudicaton for a serious traffice violation (as defined by Texas Transportation Code 522.003(25); or

(2) Forfeited bond or collateral for, or been convicted of, any other violation of motor laws or ordinances (other than parking violations) Yes  No

If yes, state where, when, and the nature of the offense 

In the past two years, have you failed an empoyer's alcohol r drug test? Yes  No

If you answered yes, explain


Driving Experience

Provide you work history information for the past 110 years n all jobs which you were a driver of a commercial vehicle, List the most recent experience first. 

Employer name 

Employer address 

Employer Phone 

Kind of work 

Dates employed 

Reason for leaving 


Employer name 

Employer address 

Employer Phone 

Kind of work 

Dates employed 

Reason for leaving 


Employer name 

Employer address 

Employer Phone 

Kind of work 

Dates employed 

Reason for leaving 


Employer name 

Employer address 

Employer Phone 

Kind of work 

Dates employed 

Reason for leaving 


Employer name 

Employer address 

Employer Phone 

Kind of work 

Dates employed 

Reason for leaving 


Verification

I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge and understand that any deliberate falsifications, misrepresentations, or omissions of fact may be grounds for rejection of my application or dismissal form subsequent employment.

I understand that the district is required by Title 37 Texas Administrative Code 14.14(b) to review my complete driving record, is required by federal regulations to obtain alcohol and drug testing results from previous employers for two years prior t this application, and is required by Texas Education Code 22.0833 and Transportation Code 521.022(f) to conduct a criminal history record check. I also understand that after employment, I am required to pass a physical examination and drug test.

Furthermore, I authorize the information I've provided to be used; authorize previous employers to be contacted for investigative purposes' and release all parties frim any liability damages that may result from furnishing information to you.

Pease type full name    Date 

I understand that check this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document.

This application becomes the property of the district. The district reserves the right to accept or reject.


Applicants for all positions are considered without regard to race, color, sex, (including pregnancy), national origin, religion, age, disability, genetic information, veteran or military status, or any other legally protected status. Additionally, the district does not discriminate against an applicant who acts to oppose such discrimination or participates in the investigation of a complaint related to a discriminating employment practice.


The district Title IX coordinator is: Amy Dickson
                          Superintendent of Karnack ISD
                          PO Box 250
                          Karnack, TX 75661


CRIMINAL HISTORY INFORMATION REQUEST

Confidential


The Karnack Independent School District is required by Texas Education Code Chapter 22, Subchapter C to review the criminal history of applicants, employees, independent contractors, student teachers, and certain volunteers. The information requested below is necessary to obtain criminal history information.

Last Name   First Name   

Middle Name 

Social Security Number 

Date of birth 

Driver's License Number 

Mailing Address

Street   City 

State   Zip 

Sex: Male  Female

Ethnicity: Black  White/Other

I understand that the information I am providing about age, sex, and ethnicity will not be used to determine eligibility for employment but will be used solely for the purpose of obtaining criminal history record information.

Pease type full name    Date 

I understand that check this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document.

This form will be removed from the application and filed separately in the HR office..


DPS Computerized Criminal History (CCH) Verification

(Agency Copy)

I, , have been notified that a Computerized Criminal History CCH) verification check will be performed by accessing the Texas Department of Public Safety Secure Website and will be on name and DOB identifiers I supply.

Because the named based information is not an exact search on only finger print record searches represent true identification to criminal history, the organization conducting the criminal history check for background screening is not allowed to discuss any criminal history record information obtained using the name and DOB method. Therefore, the agency may request that I have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search.

For the finger printing process I will be required to submit a full and complete set of my fingerprints for analysis through the Texas Department of Public Safety AFIS (Automated Fingerprint Identification System). I have been made aware that in order to complete this process I must make an appointment with LT Enrollment Services, submit a full and complete set of my fingerprints, request a copy be sent to the agency listed above, and pay a fee of $24.95 to the fingerprinting services company, L1 Enrollment Services.

Once the process is completed and the agency receives the data from DPS, the information on my fingerprint criminal history may be discussed with me.

(This copy must be retained on file by your agency. Required for future DPS audits)

Pease type full name    Date 

I understand that check this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document.

Karnack Independent School District

Agency Representative __________________________________________________

Signature of Representative ___________________________________________________

Date ____________________________________

For Agency use only

Please Check and Initial each available space

CHH Report Printed ___ Yes ___ No ____ Initial

Hire: ___ Yes  ___ No _____ Initial

Date: _______________________________________

Destroy Date _________________________________



Security Measure