Bus Driver Job Application
MALAKOFF ISD APPLICATION FOR SERVICE AND SUPPORT PERSONNEL- Bus DRIVER
1308 FM 3062 Malakoff, TX 75148 Ph 903-489-1152 Fax 903-489-2566 A11 Equal Opporttmity Employer* Date of application Name
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last Street:IJo.T
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E-mail address
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Home phone
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Afrddle initial
Mailing address State
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Cell phone
ZIP Cade
Other phone
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Other name that may appear on records (Used/or certijicalio11, refer,mce, a11d criminal history record clrecks)
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List the position(s) for which you are applying Type of employment: 0 Full-time D Part-time 0 Summer only Date you can begin work ISO in the past? 0 Yes O No
Have you been employed by If you answered yes, provide dates ofemployment
.!!l List specific skills, software proficiency, and any machines or equipment you can operate. :i Include number of years of experience. en 1. 4. .!!! 2. 5. CJ Cl)
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3.
6.
Please provide a complete list of all positions you have held in the past 10 years. List the most recent first. Attach additional sheets if necessary (bus driver applicants, see addendum). Attach resume if available. Cl)
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Employer name and location
Employer name and location
Positionltitle held
PositiorJtitle held
Dates employed
Dates employed
Supervisor's name and phone
Supervisor's name and phone
Reason for leaving
Reason for leaving
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HR Services
(0 5/2412016 Texas Association of School Boards, Inc. All rights reserved.
MALAKOFF ISO APPLICATION FOR SERVICE AND SUPPORT PERSONNEL- Bus DRIVER
Employer name and location
Employer name and location
Position/title held
Position/title held
Dates employed
Dates employed
Supervisor's name and phone
Supervisor's name and phone
Reason for leaving
Reason for leaving
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Please list references the district can contact regarding your work history. Full name of reference
School district/ firm name
Mailing address
Position/title
Area code/ phone number
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List the highest level of education attained: Licenses and certificates granted
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Name and location of schools attended
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Course of study and major/minor
Diploma, degree, certificate, or license granted
Year graduated , r~IIDnD ~nl,oi
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HR Strvim
0 5/2412016 Texas Association of School Boards, Inc. All rights reserved.
MALAKOFF 15D APPLICATION FOR SERVICE AND SUPPORT PERSONNEL- Bus DRIVER
Do you have a relative who serves on the Board of Education or is an employee of ISO?
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Yes D No If yes, please provide the relative's name and relationship:
Have you ever been convicted of, pied guilty or no contest (nolo contendre) to, or received probation, suspension, or deferred adjudication for a felony or any offense involving moral turpitude (including, but not limited to, theft, rape, murder, swindling, and indecency with a minor)? Yes No
If yes, please state where, when, and the nature of the offense
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(A felony conviction is not an automatic bar to employment. The district will consider the nature, date, and relationship between the offense and the position for which )OU arc applying,)
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 from subsequent employment.
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I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all such parties from liability for any damage that may result from furnishing the same to you.
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I understand that the district is required by Texas Education Code to review criminal history of applicants.
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Signature
Date
This application becomes the property of the district. The district reserves the right to accept or reject it. This application shall be considered active for _ _ months. If you have not received a response during this time period, you may reapply or reactivate your application.
•Applicantsfor 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 discriminale against an applicant who acts to oppose such discrimination or participates in the investigation ofa complaint related to a discriminating employment practice,
The district Titie IX Coordinator is _...,{!.,.na=n__1__e.._,... ti=tl=e.'-'a=d=d""'1..a:;·e=ss=•..aa=n=d;,Jp:a..:h=o=n=e'-'1=11="=nb=e=1_,_·)_____,_
•
im
HR Sl!rvices
(C) 5124/2016 Texas Association of School
Boards, Inc. All rights reserved.
MALAKOFF ISO APPLICATION ADDENDUM FOR SCHOOL Bus DRIVERS
Usedfor all personnel who are required to have a CDL. Au Eq11al Oooorttmity Employer*
Name
Phone number last
...caca
C
ni C
0
I!!
First
Hours available for work
Middl~ initial
Driver's license number
Type _
Do you have a Texas School Bus Driver Training Certificate?
Yes
Have you ever had a driver's license suspended, revoked, or cancelled? If you answered yes, explain
No
D Yes
No
CD
0.
Are there any criminal charges or proceedings pending against you? If you answered yes, explain
C
Yes
No
In the past 10 years, have you:
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;;
(1) been convicted of or received deferred adjudication, probation, or other adjudication for a serious traffic 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
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If yes, state where, when, and the nature of the offense
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m In the past two years, have you failed an employer's alcohol or drug test? If you answered yes, explain
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HR Services
Yes
No
(I) 111112013 Texas Association of School Board, Inc. All rights reserved.
MALAKOFF 15D APPLICATION ADDENDUM FOR SCHOOL Bus DRIVERS
Provide your work history infonnation for the past 10 years on all jobs for which you were a driver of a commercial motor vehicle. List the most recent experience first. Continue on another sheet if necessary. Employer address and phone
Kind of work
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Dates employed
Reason for leaving
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I hereby affinn that all infonnation provided in this addendum is true and accurate to the best ofmy knowledge and understand that any deliberate falsifications, misrepresentations, or omissions of fact may be grounds for rejection of my application or dismissal from subsequent employment.
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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 to this application, and is required by Texas Education Code §22.0833 and Transportation Code §521.022 (t) to conduct a criminal history record check. I also understand that after employment, I am required to pass a physical examination and drug test. Furthennore, I authorize the infonnation I've provided to be used; authorize previous employers to be contacted for investigative purposes; and release all parties from any liability for damage that may result from furnishing infonnation to you.
Signature
Dale
•Applicantsfor all positions are considered without regard to mce, color, sex (including pregnancy), national origin, religion, age, disability, genetic infomiation, 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 im•estigation ofa complaint related to a discriminating employment practice.
The district Title IX Coordinator is
•
im
HR Ser11ice1
Randv Peny
~ 11/1/2013 Texas AssoclaUon of School Board, Inc. All rights reserved.
CRIMINAL HISTORY RECORD INFORMATION REQUEST Confidential *
The Malakoff Independent School District is required by state law to review the criminal history of applicants, employees, student teachers, and volunteers. The information requested below is necessary to obtain criminal history record information.
Please print Name:
..,La.... s r ' - - - - - - - - - - - - - - - - - ' - ' F , " - ' r s a . , . I- - - - - - - - - - - = M = , d = dl« :,.._ _ _ __
Date of birth Sex:
-----------
D Male
D Female
Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one)
D D
Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or
Other Spanish culture or origin, regardless of race. Not Hispanic/Latino
Part 2. Race What is the person's race? (Choose one or more)
D
American Indian or Alaska Native - A person having origins in any of the original peoples of North and
South America (including Central America), and who maintains a tribal affiliation or community attachment.
D
Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, The Philippine Islands, Thailand, and Vietnam.
D
Black or African American - A person having origins in any of the black racial groups of Africa.
D
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific Islands.
D
White - A person having origins in any of the original peoples of Europe, the Middle East, or North
Africa. 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. Signature
Date
* This fonn will be removed from the application and filed separately in the HR office.
Malakoff Independent School District Pre-Emp]oyment Affidavit for AppJicant For purposes ofthis affidavit:
Adjudication and conviction refer to a conviction, plea ofguilty or no contest (nolo contendre), probation, suspension, or deferred adjudication. Charge refers to a formal criminal charge as documented by a primary charging instrument (a complaint, information, or indictment) under the Texas Code ofCriminal Procedure. Inappropriate relationship refers to the crime ofimproper relationship between educator and student in Texas Penal Code section 21.12, and any other inappropriate relationship as determined by the State Boardfor Educator Certification.
I declare the following:
D
I have never been charged with, adjudicated for, or convicted of having an inappropriate relationship with a minor. I hove been charged with, adjudicated for, or convicted of having an inappropriate relationship with a minor. The charge, adjudication, or conviction was determined to be fill.R. The following are all of the relevant facts pertaining to the charge, adjudication, or conviction: I have been charged with, adjudicated for, or convicted of having an inappropriate relationship with a minor. The charge, adjudication, or conviction was determined to be true. The following are all of the relevant facts pertaining to the charge, adjudication, or conviction:
-·------- ------ ----------- ----- --------- .. ------- ---------------- ------- --- ------·-.....--.....------- --- --- ------ --·--- ------ ----Dedaration of Applicant The following affidavit is offered to satisfy the requirement ofTexas Education Code section 21.009 for a pre-employment affidavit, in accordance with Texas Civil Practices and Remedies Code section 132.001. An applicant who is offered employment will be asked to complete a notarized affidavit attesting to the same.
I declare under penalty of perjury that the foregoing is true and correct. Name (First, Middle, Last)
Date of Birth
Address (Street, City, State, Zip Code)
County
Executed in._ _ _ _ _ _ _County, State ofTexas, on the_ _day of._ _ _ _ _ __,____ County
Date
Month
Year
Over please
(Signature ofDeclarant}
I understand that the date ofbirth I am providing will not be used to determine eligibility for employment but will be used solely for the purpose ofthis pre-employment affidavit•
'This form will be removed from the application and filed separately in the HR office. Approved by the Texas Commissioner ofEducation, October 2017.
1308 FM 3062 Malakoff, TX 75148 Ph 903-489-1152 Fax 903-489-2566 A11 Equal Opporttmity Employer* Date of application Name
.! cu
C
ni
last Street:IJo.T
C
E-mail address
en
Home phone
.. 0
FirM
Afrddle initial
Mailing address State
C'tl)'
Cell phone
ZIP Cade
Other phone
Cl)
ll..
Other name that may appear on records (Used/or certijicalio11, refer,mce, a11d criminal history record clrecks)
.! cu C
C
0
; en 0
ll..
List the position(s) for which you are applying Type of employment: 0 Full-time D Part-time 0 Summer only Date you can begin work ISO in the past? 0 Yes O No
Have you been employed by If you answered yes, provide dates ofemployment
.!!l List specific skills, software proficiency, and any machines or equipment you can operate. :i Include number of years of experience. en 1. 4. .!!! 2. 5. CJ Cl)
C.
(/)
3.
6.
Please provide a complete list of all positions you have held in the past 10 years. List the most recent first. Attach additional sheets if necessary (bus driver applicants, see addendum). Attach resume if available. Cl)
CJ
C
Employer name and location
Employer name and location
Positionltitle held
PositiorJtitle held
Dates employed
Dates employed
Supervisor's name and phone
Supervisor's name and phone
Reason for leaving
Reason for leaving
Cl)
·c Cl) C.
>< w
..
.ll::
0
3:
•
iii
HR Services
(0 5/2412016 Texas Association of School Boards, Inc. All rights reserved.
MALAKOFF ISO APPLICATION FOR SERVICE AND SUPPORT PERSONNEL- Bus DRIVER
Employer name and location
Employer name and location
Position/title held
Position/title held
Dates employed
Dates employed
Supervisor's name and phone
Supervisor's name and phone
Reason for leaving
Reason for leaving
C1>
u C
Cl)
.i: Cl)
C. )(
w
...0
~
~
Please list references the district can contact regarding your work history. Full name of reference
School district/ firm name
Mailing address
Position/title
Area code/ phone number
Cl)
Cl)
u C
... Cl)
.! Cl) ~
List the highest level of education attained: Licenses and certificates granted
0,
·C C
...cu
Name and location of schools attended
t:C
Course of study and major/minor
Diploma, degree, certificate, or license granted
Year graduated , r~IIDnD ~nl,oi
0
~
n,
u
::, "O
w
•
im
HR Strvim
0 5/2412016 Texas Association of School Boards, Inc. All rights reserved.
MALAKOFF 15D APPLICATION FOR SERVICE AND SUPPORT PERSONNEL- Bus DRIVER
Do you have a relative who serves on the Board of Education or is an employee of ISO?
C 0
:.:;
.. ..
ns E
'2 C
ni G)
Yes D No If yes, please provide the relative's name and relationship:
Have you ever been convicted of, pied guilty or no contest (nolo contendre) to, or received probation, suspension, or deferred adjudication for a felony or any offense involving moral turpitude (including, but not limited to, theft, rape, murder, swindling, and indecency with a minor)? Yes No
If yes, please state where, when, and the nature of the offense
C
G)
C>
(A felony conviction is not an automatic bar to employment. The district will consider the nature, date, and relationship between the offense and the position for which )OU arc applying,)
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 from subsequent employment.
C 0
I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all such parties from liability for any damage that may result from furnishing the same to you.
:.:; CV
u
·~ ~
I understand that the district is required by Texas Education Code to review criminal history of applicants.
G)
>
Signature
Date
This application becomes the property of the district. The district reserves the right to accept or reject it. This application shall be considered active for _ _ months. If you have not received a response during this time period, you may reapply or reactivate your application.
•Applicantsfor 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 discriminale against an applicant who acts to oppose such discrimination or participates in the investigation ofa complaint related to a discriminating employment practice,
The district Titie IX Coordinator is _...,{!.,.na=n__1__e.._,... ti=tl=e.'-'a=d=d""'1..a:;·e=ss=•..aa=n=d;,Jp:a..:h=o=n=e'-'1=11="=nb=e=1_,_·)_____,_
•
im
HR Sl!rvices
(C) 5124/2016 Texas Association of School
Boards, Inc. All rights reserved.
MALAKOFF ISO APPLICATION ADDENDUM FOR SCHOOL Bus DRIVERS
Usedfor all personnel who are required to have a CDL. Au Eq11al Oooorttmity Employer*
Name
Phone number last
...caca
C
ni C
0
I!!
First
Hours available for work
Middl~ initial
Driver's license number
Type _
Do you have a Texas School Bus Driver Training Certificate?
Yes
Have you ever had a driver's license suspended, revoked, or cancelled? If you answered yes, explain
No
D Yes
No
CD
0.
Are there any criminal charges or proceedings pending against you? If you answered yes, explain
C
Yes
No
In the past 10 years, have you:
0
;;
(1) been convicted of or received deferred adjudication, probation, or other adjudication for a serious traffic 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
ca
E ...
.E
.5
.:.::
u
CD
~
(.)
If yes, state where, when, and the nature of the offense
-c C
::::s
0 I., C)
.:.:: u
ca
m In the past two years, have you failed an employer's alcohol or drug test? If you answered yes, explain
•
iffl
HR Services
Yes
No
(I) 111112013 Texas Association of School Board, Inc. All rights reserved.
MALAKOFF 15D APPLICATION ADDENDUM FOR SCHOOL Bus DRIVERS
Provide your work history infonnation for the past 10 years on all jobs for which you were a driver of a commercial motor vehicle. List the most recent experience first. Continue on another sheet if necessary. Employer address and phone
Kind of work
Cl)
u
Dates employed
Reason for leaving
C
Cl)
·c Cl) a. )( w
0,
C
·s;
·c C
I hereby affinn that all infonnation provided in this addendum is true and accurate to the best ofmy knowledge and understand that any deliberate falsifications, misrepresentations, or omissions of fact may be grounds for rejection of my application or dismissal from subsequent employment.
C
0
;;
cu
CJ
q::
·c (1)
>
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 to this application, and is required by Texas Education Code §22.0833 and Transportation Code §521.022 (t) to conduct a criminal history record check. I also understand that after employment, I am required to pass a physical examination and drug test. Furthennore, I authorize the infonnation I've provided to be used; authorize previous employers to be contacted for investigative purposes; and release all parties from any liability for damage that may result from furnishing infonnation to you.
Signature
Dale
•Applicantsfor all positions are considered without regard to mce, color, sex (including pregnancy), national origin, religion, age, disability, genetic infomiation, 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 im•estigation ofa complaint related to a discriminating employment practice.
The district Title IX Coordinator is
•
im
HR Ser11ice1
Randv Peny
~ 11/1/2013 Texas AssoclaUon of School Board, Inc. All rights reserved.
CRIMINAL HISTORY RECORD INFORMATION REQUEST Confidential *
The Malakoff Independent School District is required by state law to review the criminal history of applicants, employees, student teachers, and volunteers. The information requested below is necessary to obtain criminal history record information.
Please print Name:
..,La.... s r ' - - - - - - - - - - - - - - - - - ' - ' F , " - ' r s a . , . I- - - - - - - - - - - = M = , d = dl« :,.._ _ _ __
Date of birth Sex:
-----------
D Male
D Female
Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one)
D D
Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or
Other Spanish culture or origin, regardless of race. Not Hispanic/Latino
Part 2. Race What is the person's race? (Choose one or more)
D
American Indian or Alaska Native - A person having origins in any of the original peoples of North and
South America (including Central America), and who maintains a tribal affiliation or community attachment.
D
Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, The Philippine Islands, Thailand, and Vietnam.
D
Black or African American - A person having origins in any of the black racial groups of Africa.
D
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific Islands.
D
White - A person having origins in any of the original peoples of Europe, the Middle East, or North
Africa. 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. Signature
Date
* This fonn will be removed from the application and filed separately in the HR office.
Malakoff Independent School District Pre-Emp]oyment Affidavit for AppJicant For purposes ofthis affidavit:
Adjudication and conviction refer to a conviction, plea ofguilty or no contest (nolo contendre), probation, suspension, or deferred adjudication. Charge refers to a formal criminal charge as documented by a primary charging instrument (a complaint, information, or indictment) under the Texas Code ofCriminal Procedure. Inappropriate relationship refers to the crime ofimproper relationship between educator and student in Texas Penal Code section 21.12, and any other inappropriate relationship as determined by the State Boardfor Educator Certification.
I declare the following:
D
I have never been charged with, adjudicated for, or convicted of having an inappropriate relationship with a minor. I hove been charged with, adjudicated for, or convicted of having an inappropriate relationship with a minor. The charge, adjudication, or conviction was determined to be fill.R. The following are all of the relevant facts pertaining to the charge, adjudication, or conviction: I have been charged with, adjudicated for, or convicted of having an inappropriate relationship with a minor. The charge, adjudication, or conviction was determined to be true. The following are all of the relevant facts pertaining to the charge, adjudication, or conviction:
-·------- ------ ----------- ----- --------- .. ------- ---------------- ------- --- ------·-.....--.....------- --- --- ------ --·--- ------ ----Dedaration of Applicant The following affidavit is offered to satisfy the requirement ofTexas Education Code section 21.009 for a pre-employment affidavit, in accordance with Texas Civil Practices and Remedies Code section 132.001. An applicant who is offered employment will be asked to complete a notarized affidavit attesting to the same.
I declare under penalty of perjury that the foregoing is true and correct. Name (First, Middle, Last)
Date of Birth
Address (Street, City, State, Zip Code)
County
Executed in._ _ _ _ _ _ _County, State ofTexas, on the_ _day of._ _ _ _ _ __,____ County
Date
Month
Year
Over please
(Signature ofDeclarant}
I understand that the date ofbirth I am providing will not be used to determine eligibility for employment but will be used solely for the purpose ofthis pre-employment affidavit•
'This form will be removed from the application and filed separately in the HR office. Approved by the Texas Commissioner ofEducation, October 2017.
