PUTNAM COUNTY CHARTER SCHOOL SYSTEM

Application for Employment as School Bus Driver/Monitor

Application for Employment as: ______Date: ______

Name: ______

Address: ______

Home Phone: ______Cell Phone: ______Email Address: ______Date Available for Employment: ______

In order to provide statistical information relative to applications for employment, we are requesting that you voluntarily complete the following information.

Gender: ____ Male ____ Female

Ethnicity: _____ American Indian or Alaskan Native _____ Asian or Pacific Islander _____ Hispanic

_____ Black, Not of Hispanic Origin _____ White

Educational/Professional Training

Name and Address of School
(Include High School, College & Trade School) / Dates Attended / Degree/Diploma

CDL License: ____Yes ____ No Are you presently 21 years of age or older? ____ Yes ____ No

Employment Record

(List all previous experiences, beginning with most recent. Include current education and non-educational work experience)

Dates / Position / Name/Address of Employer / Reason for Leaving

Professional Reference

List three (3) former supervisors or managers from whom you will request references. (Forms are attached to this application. Do not include neighbors, friends or relatives.

Name and Title / Address / Phone Number

Military Service:

(Active Duty Only)

Branch / Dates of Service / Highest Rank / Type of Discharge

Background Information:

Each of the following questions must be answered with a “yes” or “no.” If any answer is “yes,” please attach an explanation. YES NO
1.  Have you ever been dismissed from employment, asked to resign, not been reappointed, not offered another contract or resigned in lieu of dismissal?
2.  Have you ever been found guilty, entered a plea of nolo contendere, been granted first offender treatment without adjudication of guilt, been placed under a court order whereby any adjudication or sentence was otherwise withheld for any misdemeanor involving moral turpitude or for any felony, or is any charge currently pending against you, including issuance of a bad check?
3.  Have you ever had a driver’s license suspended or revoked?
4.  Have you ever been investigated for any act of alleged discrimination including: discrimination on account of race, color, gender, religion, age, national origin, or handicapping condition?
5.  Have you ever received a dishonorable discharge from the armed services?
6.  Have you ever been investigated for allegations of sexual harassment?
7.  Have you ever been accused and investigated for a crime of child abuse or physical abuse?
8.  Are you legally authorized to work in the United States as a United States Citizen or a non-citizen with employment authorization? (Proof of eligibility will be required before you can begin to work)

AUTOBIOGRAPHY

Please write in your own handwriting a response to the following question: Why are you uniquely qualified for this position and why should you be selected over other candidates?

______

______

By filing an application for employment with the Putnam County Board of Education, I understand that any misrepresentation or omission of facts on the application may be cause for termination. If employed, I agree to abide by all the policies set forth by the Putnam County Board of Education. As an applicant for position of School Bus Driver/Monitor, I understand that I am subject to a criminal background check, which includes the requirement of fingerprinting. I also understand that I must undergo a drug test before employment and if employed I will be subject to random drug testing.

Signature of Applicant ______Date ______

Submit application or mail completed application to the following address:

Putnam County Charter School System

Human Resources Office

158 Old Glenwood Springs Road

Eatonton, GA 31024

Please Return to:

Putnam County Board of Education

Name of Applicant: ______158 Old Glenwood Springs Rd

Eatonton, GA 31024

Position Applying for: ______Tel: 706-485-5381

Fax: 706-485-3820

I understand the information is confidential and will not be shared with me. I waive all rights of examination.

______Applicant’s Signature and Date

The person named has applied for a position with the Putnam County School System and has listed you as a Reference. Your evaluation will be a service to this office, the applicant, and possibly the children in our system. Please note that your evaluation will NOT be shared with the applicant.

PLEASE DO NOT RETURN THIS FORM TO THE APPLICANT

Not Observed / Poor / Average / Good / Superior
WORK HABITS
Attendance
Punctuality
Follows Instruction
Observation of Work Rules
ATTITUDE
A Diligent Worker
Work Well with Others
Shows Initiative
Exhibits Tact and Self-control
Attitude Toward Staff and Students
PERFORMANCE & PRODUCTION
Quality of Work
Shows Good Judgment
Learns New Skills Easily
Promptness, Neatness and Accuracy with Reports and Records

Should we telephone you for additional evaluation? ______Yes ______No

How long have you known the applicant? ______What is your relationship with the applicant? ______

If the applicant was an employee: Name of Business ______

Position Held ______Dates of Service ______

Would you rehire this individual? ______

WOULD YOU FEEL COMFORTABLE WITH THIS APPLICANT WORKING NEAR OR AROUND YOUR CHILD OR OTHER CHILDREN? ______Yes ______No

Comments:______

______

______

Signature Printed Name Phone Number


Please Return to:

Putnam County Board of Education

Name of Applicant: ______158 Old Glenwood Springs Rd

Eatonton, GA 31024

Position Applying for: ______Tel: 706-485-5381

Fax: 706-485-3820

I understand the information is confidential and will not be shared with me. I waive all rights of examination.

______Applicant’s Signature and Date

The person named has applied for a position with the Putnam County School System and has listed you as a Reference. Your evaluation will be a service to this office, the applicant, and possibly the children in our system. Please note that your evaluation will NOT be shared with the applicant.

PLEASE DO NOT RETURN THIS FORM TO THE APPLICANT

Not Observed / Poor / Average / Good / Superior
WORK HABITS
Attendance
Punctuality
Follows Instruction
Observation of Work Rules
ATTITUDE
A Diligent Worker
Work Well with Others
Shows Initiative
Exhibits Tact and Self-control
Attitude Toward Staff and Students
PERFORMANCE & PRODUCTION
Quality of Work
Shows Good Judgment
Learns New Skills Easily
Promptness, Neatness and Accuracy with Reports and Records

Should we telephone you for additional evaluation? ______Yes ______No

How long have you known the applicant? ______What is your relationship with the applicant? ______

If the applicant was an employee: Name of Business ______

Position Held ______Dates of Service ______

Would you rehire this individual? ______

WOULD YOU FEEL COMFORTABLE WITH THIS APPLICANT WORKING NEAR OR AROUND YOUR CHILD OR OTHER CHILDREN? ______Yes ______No

Comments:______

______

______

Signature Printed Name Phone Number

Please Return to:

Putnam County Board of Education

Name of Applicant: ______158 Old Glenwood Springs Rd

Eatonton, GA 31024

Position Applying for: ______Tel: 706-485-5381

Fax: 706-485-3820

I understand the information is confidential and will not be shared with me. I waive all rights of examination.

______Applicant’s Signature and Date

The person named has applied for a position with the Putnam County School System and has listed you as a Reference. Your evaluation will be a service to this office, the applicant, and possibly the children in our system. Please note that your evaluation will NOT be shared with the applicant.

PLEASE DO NOT RETURN THIS FORM TO THE APPLICANT

Not Observed / Poor / Average / Good / Superior
WORK HABITS
Attendance
Punctuality
Follows Instruction
Observation of Work Rules
ATTITUDE
A Diligent Worker
Work Well with Others
Shows Initiative
Exhibits Tact and Self-control
Attitude Toward Staff and Students
PERFORMANCE & PRODUCTION
Quality of Work
Shows Good Judgment
Learns New Skills Easily
Promptness, Neatness and Accuracy with Reports and Records

Should we telephone you for additional evaluation? ______Yes ______No

How long have you known the applicant? ______What is your relationship with the applicant? ______

If the applicant was an employee: Name of Business ______

Position Held ______Dates of Service ______

Would you rehire this individual? ______

WOULD YOU FEEL COMFORTABLE WITH THIS APPLICANT WORKING NEAR OR AROUND YOUR CHILD OR OTHER CHILDREN? ______Yes ______No

Comments:______

______

______

Signature Printed Name Phone Number

The Putnam County School System prohibits discrimination in employment, educational programs, and activities on the basis of race, color, national origin, sex, religion, age or disability.

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