Medina ISD

Addendum for School Bus Driver Applicants Only

Last Name:

First Name:

Middle Name:

Phone No.

Hours Available for Work:

Driver’s License No.

Driver’s License Type:

School Bus Certification:

Yes

Have you ever had a license suspended, revoked or canceled?

Reaquired field: Yes

Reaquired field: No

If yes, please explain:

Are any criminal charges or proceedings pending against you?

Reaquired field: Yes

Reaquired field: No

If yes, please explain:

In the past two years have you failed an alcohol or drug test given by an employer?

Reaquired field: Yes

Reaquired field: No

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

Have you even been convicted of any serious traffic violation? Copy

Reaquired field: Yes

Reaquired field: No

If yes, please explain:

Criminal History Record Information Request

WORK EXPERIENCE

Specify work history information for the past 10 years on all jobs for which you were a driver of a commercial motor vehicle. List most recent experience first.

Employer Address

Employer Phone

Kind of Work

Dates Employed

Reason for Leaving

Employer Address

Employer Phone

Kind of Work

Dates Employed

Reason for Leaving

Employer Address

Employer Phone

Kind of Work

Dates Employed

Reason for Leaving

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 I understand that any deliberate falsifications, misrepresentations or omissions of fact may be grounds for rejection of my application or dismissal from subsequent employment. I understand that the district is required by federal regulations to obtain alcohol and drug testing results from previous employers for two years prior to the date of this application. Furthermore, I authorize this information provided above to be used, and previous employers may be contacted for investigation purposes and that all parties are released from any liability for any damage that may result from furnishing information to you. If you agree to this statement type your full name and current date in the box below:

Email a copy to

optional

Required Fields

MEDINA ISD

Online School Bus Driver Application