Application

Application for Employment

PERSONAL INFORMATION

Name(Required)
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Have you ever worked or attended school under a different name?(Required)

Addresses for past three years:

(Street) (City) (State) (Zip) How long?
(Street) (City) (State) (Zip) How long?

JOB INTEREST

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Job Type
Previously employed by Beach Transportation Company
Do you foresee any schedule conflicts if you were assigned a bus run before 09:00 am and/or after 2:00 pm?(Required)

DRIVING EXPERIENCE

The following questions are asked so that we may obtain commercial drivers license and motor vehicle record information.

Do you have a commercial drivers license?(Required)
If you do not currently have a commercial drivers license, are you able to obtain one?(Required)

List all driver's licenses ever held.

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Has any license you have ever held been:

Suspended(Required)
Revoked(Required)

For how long?

How many years have you been driving?

How many years have you been driving commercially?

Record length of time driving each type of vehicle:

Truck

Yrs

Bus

Yrs

Farm vehicle

Yrs

Van or Delivery

Yrs

Private Auto

Yrs

Other

Yrs

DRIVING RECORD

How many as the operator of a:

Last Accident

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Next Previous

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Next Previous

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Next Previous

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List all traffic violations, other than parking, for which you have ever been convicted

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SPECIALS SKILLS AND TRAINING

First Aid(Required)
C P R(Required)

Summary of Qualifications: Itemize in descriptive form any other directly related experiences or skills which would qualify you for the job duties or responsibilities you seek. indicate where they were obtained and approximately how much time was spent in obtaining, developing, and applying each.

EMPLOYMENT RECORD

Beginning with the most recent, please describe your employment history during the last 10 years, including military service and periods of unemployment. (if additional space is required, ask for a supplemental sheet.)

*The Federal Motor Carrier Safety Regulations (FMCSR) apply to anyone who operates a motor vehicle on a highway in interstate commerce to transport passangers orr property when the vehicle: (1) has a GVWR or weights 26,001 pounds or more, (2) is designed or used to transport 16 or more passangers, or, (3) is of any size, used to transport hazardous materials in a quantitiy requiring placarding.

(Address) (City) (State) (ZIP)
Were you subject to the Federal Motor Carrier Safety Regulations* while employed here?
Was your job designed as a safety-sensitive function subject to the Department of Transportation's drug and alcohol testing requirements?

(Address) (City) (State) (ZIP)
Were you subject to the Federal Motor Carrier Safety Regulations* while employed here?
Was your job designed as a safety-sensitive function subject to the Department of Transportation's drug and alcohol testing requirements?

(Address) (City) (State) (ZIP)
Were you subject to the Federal Motor Carrier Safety Regulations* while employed here?
Was your job designed as a safety-sensitive function subject to the Department of Transportation's drug and alcohol testing requirements?

Have you ever been discharged by a previous employer?

GENERAL INFORMATION

Have you ever been convicted of a felony or misdemeanor? (Does not include any traffic violations, juvenile offenses, or military convictions, except by general court martial)(Required)
I am a U.S. Citizens or National of the U.S., an alien lawfully admited for permanent residence, or an alien authorized to work in the U.S.(Required)

NOTE: Upon request, prior to commencement of employment, you must provide documents which establish your identify and authorization to work in the United States.

REFERENCES

Please list three personal or business references other than relatives or former employers.

AGREEMENTS --- CERTIFICATIONS --- CONSENTS

I authorize an inquiry to collect information relating to data contained in my application, my character, general reputation, personal characteristics, criminal record history and motor vehicle record. I authorize all individuals, corporations, organizations and agencies who possess information about me, to release to Beach Transportation Company Incorporated and its designated representatives (“The Company”), all such information and to allow copying of any qualifications for the type of work requested. I release and hold harmless each designated representatives of any of them from all liabilities or claims arising from any inquiry concerning me, or release of any information concerning me to The Company.

I understand the importance of safety in transportation and realize that drug and alcohol consumption may detrimentally affect a person’s ability to work safely. I consent, as a part of the processing of my application for employment and, if employed, periodically thereafter, to the collection and analysis of samples of the blood, breath, and/or urine, for the purpose of detecting drug and alcohol consumption, and to the reporting of the findings of such analysis to The Company, in accordance with all applicable state and federal laws.

I further agree to submit to a physical examination if so requested by The Company, in accordance with state and federal law. I realize the importance of good health in transporting human lives and therefore, realize that my employment may be terminated or modified at the discretion of The Company if physical or medical problems develop that would compromise the safety of the human lives that are in my charge.

I acknowledge that the acceptance of this application does not create an offer of employment, and that any offer of employment may be withdrawn at any time by The Company. In the event I am hired by The Company and in consideration for my employment by The Company, I agree to conform to all rules and regulations of The Company, either presently existing or as further modified.

I certify that the information contained in the application or supplementary materials is correct and complete.

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COMPANY USE ONLY

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Approvals:

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