Central Noble
Jr/Sr High School

Application for Bus Driver Position

Conditions of employment are stated at the end of this form. Please read carefully before you sign this application. Application must be completed in full even if attaching a resume.

PERSONAL INFORMATION

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ADDRESS HISTORY

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Street, City, State, Zip Code

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Street, City, State, Zip Code

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Street, City, State, Zip Code

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State

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License Number

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Type

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Expiration Date


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DRIVER EXPERIENCE

Type of Equipment

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From


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To


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Approximate Miles

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If you answered Yes to either of the above 2 questions, please attach a statement of explanation.

TICKETS / ACCIDENTS / ETC

Accident Record for the Past 3 Years

Date


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Description

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Number of Injuries/Fatalities

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Traffic Convictions & Forfeitures for the Past 3 Years

Location

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Date


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Charge

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Penalty

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ATTENDANCE AND PUNCTUALITY INFORMATION

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REFERENCES

Please list 3 References - no relatives.

Reference 1

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Reference 2

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Reference 3

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EMPLOYMENT HISTORY

DOT requires employment history for previous 3 years and/or past 10 years for commercial driving experiences be shown. Begin with your most recent employment:

Employer 1

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Leave blank if still currently working for this employer.

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Employer 2

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Employer 3

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IF YOU HAVE MORE THAN 3 EMPLOYERS, PLEASE REQUEST A SUPPLEMENTAL EMPLOYMENT HISTORY FORM.

PLEASE ATTACH A COPY OF YOUR COLLEGE TRANSCRIPTS AND RESUME AT THE END OF THIS FORM.

DECLARATION OF EMPLOYMENT STATUS

I understand that I must provide my complete employment history for the past 3 years, and all CDL required employment for the 7 years preceding that. Any gaps in employment for longer than 1 month are explained as follows:


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TO BE READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interviews may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Corporation.

I understand that information I provide regarding current and/or previous employers may be used, and those employers will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (d) and (e). I understand that I have the right to:
  • Review information provided by the previous employers;
  • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

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Enter your full Legal Name

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

In accordance with the provisions of Section 604 (b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports and required by Sections 382.413 and 391.25 of the Federal Motor Carrier Safety Regulations.

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Enter your full Legal Name

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Enter your 9-digit SSN

ALCOHOL AND CONTROLLED SUBSTANCE CONSENT AND RELEASE

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If you answered Yes to any of the above questions, attach a statement of explanation and provide proof of return to duty process.

I understand that, as required by the Federal Motor Carrier Safety Regulations and company policy, all drivers must submit to alcohol and controlled substance testing as a condition of employment. I also understand that any offer of employment will be contingent upon the results of an alcohol and controlled substance test.

Therefore, I agree to submit to the following alcohol and controlled substance tests in accordance and as defined by the Federal Motor Carrier Safety Regulation and this company’s policies:

  • Pre-Employment, to determine employment eligibility
  • Random
  • Reasonable Suspicion
  • Post Accident

I certify that I have read, understand, and agree to abide by the condition of this consent and release form.

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Enter your full Legal Name

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Enter your 9-digit SSN

CERTIFICATION OF COMPLIANCE WITH DRIVER LICENSE REQUIREMENTS

MOTOR CARRIER INSTRUCTIONS: The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements are in effect as of July 1, 1987. They are as follows:

  1. You, as a commercial vehicle driver, may not possess more than one license. The only exception is if a state requires you to have more than one license. This exception is allowed until January 1, 1990. If you currently have more than one license, you should keep the license from your state of residence, and return the additional licenses to the states that issued them. Destroying a license does not close the record in the state that issued it: you must notify the state. If a multiple license has been lost, stolen, or destroyed, you should close your record by notifying the state of issuance that you no longer want to be licensed by that state.
  1. Sections 392.42 and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer the NEXT BUSINESS DAY of any revocation or suspension of your driver’s license. In addition, Section 383.31 requires that any time you violate a state or local traffic law (other than parking), you must report it to your employing motor carrier and the state that issued your license within 30 days.

DRIVER CERTIFICATION: I certify that I have read and understand the above requirements.

The following license is the only one I will possess:
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Enter your full Legal Name

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EMPLOYABILITY VERIFICATION

Only US Citizens or Aliens who have a legal right to work in the US are eligible for employment.
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A conviction record will not necessarily be a bar to employment. Factors such as job relations, age and time of the offense, seriousness and nature of violation and rehabilitation will be taken into account.

A conviction record will not necessarily be a bar to employment. Factors such as job relations, age and time of the offense, seriousness and nature of viloation, and rehabilitation will be taken into account.
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NOTIFICATION AND AGREEMENT

PLEASE READ BEFORE SIGNING:

I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION, OR OMISSION OF FACT ON THIS APPLICATION (OR ANY OTHER ENCLOSED OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN OR HOW DISCOVERED.

Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of the Corporation to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local Law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I release the employer from all liability that might result from making an investigation.

Indiana is an “At-Will” State. If hired, I agree to abide by all of the School rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the Corporation or me, I further understand that no representation, whether oral or written by any representative or agent of the Corporation, at any time, can constitute a contract of employment. I understand that the Corporation and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance, or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of the Corporation, has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the Superintendent and/or Board, or to make any agreement contrary to the foregoing.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

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You may upload relevant documents like certifications, licenses, reference letters, or a resume.

Central Noble encourages acceptance, tolerance, and respect for all students. When you feel hurt or bullied, visit our CN Cares Hotline page.

Corporation Office

  • 260-636-2175
  • 260-636-7918

Jr/Sr High

  • 260-636-2117
  • 260-636-2461

Elementary

  • 260-636-7538
  • 260-636-7740

Primary

  • 260-635-2432
  • 260-635-2372

Central Noble encourages acceptance, tolerance, and respect for all students. When you feel hurt or bullied, visit our CN Cares Hotline page.