AUGUSTA COUNTY SCHOOL BOARD
TRANSPORTATION DEPARTMENT
146 Hornet Road
Fishersville, VA 22939
(540) 245-5143, (540) 949-6134
APPLICATION FOR BUS DRIVER
Complete all portions of this application, including back page. We appreciate the time you spend completing this application. The employer, in accordance with state and federal laws, does not discriminate on the basis of age, race, religion, color, sex, national origin, ancestry, mental or physical disability, or any other characteristic protected by law. State regulations require any person who operates a bus to be at least 21 years of age.
PLEASE PRINT
Name (Last) / (First) / (Middle)Mailing Address / (City & State) / (Zip)
Residential Address (911) / (City & State) / (Zip)
Phone Numbers (include cell, pager, etc.)
Home – / Cell – / Other-
Driver’s License Number / Social Security Number / Date of Birth
EMPLOYMENT RECORD
To-From- / Employer name & phone # / Address / Reason for leaving
To-
From- / Employer name & phone # / Address / Reason for leaving
To-
From- / Employer name & phone # / Address / Reason for leaving
1. / Do you hold a valid Virginia Drivers License? / / Yes / / No
2. / Do you currently hold a valid Commercial Driver’s License (CDL)? / / Yes / / No
3. / Do you currently hold a School Bus License? / / Yes / / No
4. / Have you ever been employed to drive a school bus? / / Yes / / No
5. / If yes, what school division? / city/county of / state
6. / Have you ever been convicted of a crime other than a minor traffic violation? / / Yes / / No
7. / Have you ever been charged with Reckless Driving or a DUI? / / Yes / / No
8. / Have you ever been convicted of Reckless Driving or a DUI? / / Yes / / No
Answer all questions below. Use back of Application for more room if necessary.
9. / Have you ever been charged with a felony? / / Yes / / No10. / Have you ever been convicted of a felony? / / Yes / / No
11. / Have you ever been charged with any offense involving the sexual molestation, physical, or sexual abuse or rape of a child? / / Yes / / No
12. / Have you ever been convicted of any offense involving the sexual molestation, physical, or sexual abuse or rape of a child? / / Yes / / No
13. / Have you ever been charged with a Misdemeanor? / / Yes / / No
14. / Have you ever been convicted of a Misdemeanor? / / Yes / / No
15. / Are any criminal charges pending against you? / / Yes / / No
16. / Have you ever been the subject of a founded case of child abuse or neglect? / / Yes / / No
17. / Have you ever been convicted of a crime of moral turpitude? / / Yes / / No
18. / If you answered yes to questions 7, 8, 9, 10, 11, 12, or 13 please explain on the back of this application.
19. / Classroom training may be given during the day or evenings, which best fits your schedule? Evening classes will include one day class. / / Day / / Evening
Education
A. Circle highest grade completed. 1 2 3 4 5 6 7 8 9 10 11 12 Year completed ______
B. If you did not complete high school, do you have a high school equivalency diploma (GED)? Yes No
C. Circle number of years of post high school education. 1 2 3 4 5 6 7
REFERENCES
Name Address Occupation Phone
1. ______
2. ______
3. ______
My signature authorizes the school division to conduct a background investigation and authorized release of information in connection with my application for employment. This investigation may include information as to criminal or civil convictions, driving records, previous employers and educational institutions, personal and/or professional references, and other appropriate sources. I waive my right of access to any such information, and without limitation hereby release the school division and the reference source from any liability in connection with its release or use. This release includes the sources cited above and specific examples as follows: local Sheriff, information from Criminal Records Exchange of either data on all criminal convictions or certification that no data on criminal convictions is maintained, information from Virginia or other state department of Social Services, Child Protection Services Unit and any locality to which they may refer for release of information pertaining to any findings of child abuse or neglect investigations involving me.
Furthermore, I certify that I have made true, correct and complete answers and statements on this application in the knowledge that they may be relied upon in considering my application, and I understand that any omission, false answered statement made by me on this application, or any supplement to it will be sufficient grounds for failure to employ or for my discharge should I become employed with the school division.
AS OF 7/2000 ALL NEW EMPLOYEES ARE REQUIRED TO BE FINGERPRINTED AND A BACKGROUND CHECH PERFORMED
SIGNATURE ______DATE ______
PLEASE FILL OUT BACK PAGE
THIS PAGE MUST BE COMPLETED
REQUEST FOR DRIVING RECORD TRANSCRIPT
FROM DEPARTMENT OF MOTOR VEHICLES
BY AUGUSTA COUNTY SCHOOL BOARD
Date: ______
Employee’s Full Name: (Please Print)______
(Last) (First) (Middle)
Date of Birth: ______
Social Security or Driver’s License Number: ______
I am an employee of, or have applied to become an employee of,
AUGUSTA COUNTY SCHOOL BOARD
in a position which involves, or which could involve the operation of a motor vehicle.
I authorize the Department of Motor Vehicles to furnish a copy of my driving record to said company in accordance with S46.1-31(b) of the Code of Virginia.
SIGNATURE: ______
(DO NOT WRITE BELOW THIS LINE, for Office Use Only)
I certify that the above named individual is an employee, of has applied to become an employee, of this company in a position, which involves the operation of a motor vehicle.
COMPANY NAME: AUGUSTA COUNTY SCHOOL BOARD
COMPANY ADDRESS: P. O. BOX 960 VERONA, VIRGINIA 24482
SIGNATURE: ______TITLE:
This information is furnished in accordance with the Virginia Department of Motor Vehicles Privacy Protection Act Rules and Regulations to be used for the sole purpose for which it was requested. Any other use or dissemination of the information shall be unlawful and constitute a misdemeanor.