Full Name
Address
Telephone Number
Desired Position—Please choose an option—School Bus DriverSchool Van DriverVan AidSubstitute Driver
Are you legally eligible to be employed in the United States?—Please choose an option—YesNo
Date available to start
Have you ever been convicted of a crime?—Please choose an option—YesNoIf yes, please explain
During the past five yearsHas your driver's license ever been suspended or revoked?—Please choose an option—YesNoHave you received any traffic citations, convictions and/or accidents?—Please choose an option—YesNoIf yes, please explain
Within the past year, have you completed and received the following formsCommonwealth of PA School Bus Driver's Physical Examination?—Please choose an option—YesNoFederal Criminal History Record (Fingerprints)?—Please choose an option—YesNoPennsylvania Child Abuse History Clearance?—Please choose an option—YesNoPennsylvania State Police Criminal Record Check?—Please choose an option—YesNo
If applying for school bus, do you have a valid "S" endorsement, Passenger and Air Brakes on license?—Please choose an option—YesNoIf no, which is needed
Employer
Start Date
End Date
Phone Number
Job Title
Employment Status—Please choose an option—Full TimePart Time
Supervisor Name
Reason for Leaving
Reference #1NameRelationshipPhone
Reference #2NameRelationshipPhone
agree I authorize Jacoby Transportation Inc. to conduct an inquiry into any job-related information contained in this application, including but not limited to references, past/present employers, and driving history. I am aware that any omissions, falsifications, misstatements, or misrepresentations above may disqualify me for employment consideration and, if I am hired, may be grounds for termination at a later date. I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete and made in good faith.
