Birnie Bus Service, Inc.
Corporate Office

PO Box 630
248 Otis Street
Rome, New York 13442-0630
Tel. (315) 336-3950     Fax (315) 281-0042

APPLICATION FOR EMPLOYMENT

INSTRUCTIONS TO THE APPLICANT

1. Any applicant who provides unrequested information will automatically be rejected.
2. Disabled applicants can request any accomodations needed to enable them to complete the application.
3. In compliance with Federal and State Equal Employment Opportunity Laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status or non-job related disability.
4. By State Law, certain convictions may disqualify you from employment.
5. Please provide all information as requested unless marked as optional. Incomplete applications will automatically be rejected.


Date of Application:

Position Applied For:     Driver:     Monitor:     Other:  

Location Applying For:   Primary   Secondary

Your Personal Information:

Last Name: First Name: Middle:
E-Mail:
Address:
City: State: ZIP:
SSN: Phone:

Have you worked for this company before? Yes or No:
If YES, Where?
From:     To:
Reason For Leaving:

How did you hear about us?

Do you have the legal right to work in the United States? Yes or No:
If NO, please explain:

Rate of Pay Expected: per

Driver's License #:
State:
Expiration:
Class:
Endorsements:
Any Points, DUI or DWI? Yes or No:


Have you ever been convicted of any crime:
If so, Date of conviction:
Offense:

Please note: No applicant will be automatically disqualified from consideration based on a criminal history alone. Disqualification will occur only if the crime has a bearing on the particular job applying for.

Availability For Work: Check here if you are always available
SUNDAY From: To:
MONDAY From: To:
TUESDAY From: To:
WEDNESDAY From: To:
THURSDAY From: To:
FRIDAY From: To:
SATURDAY From: To:

How long have you lived at your present address? Years: Months:

List your addresses for past seven years:

Previous Address 1:
From: To:

Previous Address 2:
From: To:

Previous Address 3:
From: To:

Emergency Contact Name:       Phone:

Your Education:

Highest Grade Completed:
Course of Study / Major:
High School Attended:
College / Professional:
Additional Training:

DRIVERS AND MONITORS: As part of the employment process, you will be required to pass a physical performance test, which includes dragging an object weighing 125 lb. and other emergency skills. Is there any reason you might be unable to perform these functions of the job for which you have applied? Yes or No:
If YES Please Explain:


Your Employment History:

Employer:
Address:
City: State: ZIP:
Phone:
Job Title:
Supervisor:
Work Performed:

Reason For Leaving:
From:
To:
Starting Wage:
Final Wage:
May we contact? Yes or No:

Employer:
Address:
City: State: ZIP:
Phone:
Job Title:
Supervisor:
Work Performed:

Reason For Leaving:
From:
To:
Starting Wage:
Final Wage:
May we contact? Yes or No:

Employer:
Address:
City: State: ZIP:
Phone:
Job Title:
Supervisor:
Work Performed:

Reason For Leaving:
From:
To:
Starting Wage:
Final Wage:
May we contact? Yes or No:

References:

Reference Name:
Phone:
Reference Name:
Phone:
Reference Name:
Phone:

Please read and check next to each statement that you understand & agree.

TRUE AND COMPLETE: This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

ADDITIONAL PHYSICALS: I understand my continued employment as a school bus driver will require I undergo annual physical examinations as mandated by federal and state law.

RELEASE FROM LIABILITY: 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.

FALSE OR MISLEADING: In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, I am required to abide by all rules and regulations of the Company.

AT-WILL EMPLOYER: Birnie Bus Service, Inc. is an at-will employer residing in the State of New York.

Signature: Todays Date:
An electronic signature/approval (e-signature) is defined as an electronic identifier that is created by a computer and is intended by the party using it to have the same intent, affect and authority as the use of a manual (either written or facsimile) signature and is legally binding under the Electronic Signatures Act (Public Law No: 106-229).


PHYSICAL AND DRUG SCREEN: Inquiries regarding medical history - including a physical - will be made only if and after a conditional offer of employment has been exteneded. As prescribed by federal and state laws or as required by contract, I understand that as a condition of my employment, a pre-employment drug screen will be required for which a negative result must be received prior to the first day of employment.

ADDITIONAL DRUG SCREENS: I understand that as part of my continued employment I may be subject to random drug screenings as mandated by federal and state law(s); that I must submit to an alcohol / drug screen if I am involved as a driver in a motor vehicle accident; and, the company may request I submit to an alcohol / drug screen if there is reasonable suspicion I am under the influence of a foreign substance.

Signature: Todays Date:
An electronic signature/approval (e-signature) is defined as an electronic identifier that is created by a computer and is intended by the party using it to have the same intent, affect and authority as the use of a manual (either written or facsimile) signature and is legally binding under the Electronic Signatures Act (Public Law No: 106-229).

Credit and Consumer Report Authorization

Authorization to Release Information

The purpose of this form is to disclose to you that the company may obtain a consumer report through a consumer reporting agency of its choice for employment purposes as part of our pre-employment background investigation and, if hired, at any time during your employment.

By signing this form, I hereby authorize the company to obtain a consumer report as part of the pre-employment background investigation.

I understand that upon my request to the company, I will be informed as to whether or not a consumer report was requested, and, if such report was requested, I will be provided with the name and address of the consumer reporting agency that furnished the report.

If you are hired, this authorization will remain on file and will serve as an ongoing authorization for the company to obtain consumer reports for employment purposes at any time during your employment.

Signature: Todays Date:
An electronic signature/approval (e-signature) is defined as an electronic identifier that is created by a computer and is intended by the party using it to have the same intent, affect and authority as the use of a manual (either written or facsimile) signature and is legally binding under the Electronic Signatures Act (Public Law No: 106-229).


Before you submit your application, you should review for accuracy. Incomplete applications will not be accepted. Please press submit only once. Multiple submissions from the same applicant will result in disqualification.




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