Escot Bus Lines - Employment Application

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, veteran status, non-job related disability, or any other protected group status.

TO BE READ AND SIGNED BY APPLICANT

I hereby authorize Escot Bus Lines to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as me be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only after a conditional offer of employment has been extended.)

I also understand that the information supplied by me regarding my employment history, education (authorization includes release of transcripts), criminal history, motor vehicle records, residence history and references will be utilized as part of the application processing procedures, and that a background investigation will be conducted to verify the veracity of the information submitted and to develop information concerning my character, general reputation, personal characteristics, and mode of living.

I hereby specifically release and indemnify Escot Bus Lines against any liability that might result from making such investigations; and I release employers, schools, health care providers, companies, corporations and all other persons, from all liability that may arise from responding to and releasing information in connection with my application.

This certifies that the information supplied during the application process was submitted by me, and that all information is true and correct to the best of my knowledge. I understand that any material misrepresentations will be cause for immediate termination.

I understand that information I provided regarding current and/or previous employers may be used, and those employer(s) 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 a right to review information provided by previous employers; have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to Escot Bus Lines; 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.

I acknowledge receipt of Escot Bus Lines Drug-Free Policy prior to taking any Pre-Employment Drug Screen, agree to read it in it's' entirety, and bring any and all questions to the Safety Managers attention.

Please answer the following questions:

Have you ever been charged with driving under the influence of drugs or alcohol in the past 7 years? : Yes No
Have you ever tested positive, or refused to test on any pre-employment drug or alcohol test? : Yes No
Do you agree with all of the above terms and conditions? Yes No
Your Full Name: Today's Date:

Positions Applied For

Positions Applied For:

Personal Information

First Name*:		Middle Name*:
Last Name*:		Home Phone Number*:
Cell Phone Number:		Email Address:
Current Street Address*:		City*:
State*:		Zipcode*:
Length of time at current residence?	years/months	Social Security Number*:
If you have a passport, when does it expire and what country was it issued in?

Previous Addresses

Previous Address 1:	Street Address:		City:
	State:		Zipcode:
	Length of time at residence?	years/months

Previous Address 2:	Street Address:		City:
	State:		Zipcode:
	Length of time at residence?	years/months

Previous Address 3:	Street Address:		City:
	State:		Zipcode:
	Length of time at residence?	years/months

Other Information

Do you have the legal right to work in the United States?	Yes No
Date of Birth: Required for Commercial Drivers:	mm-dd-yyyy	Can you provide proof of age?	Yes No
Are you now employed?	Yes No	If not, how long since leaving last employment?
Who referred you?		Rate of pay expected:
Have you ever been bonded? Answer only if a job requirement	Yes No	Name of bonding company:
Have you ever been convicted of a felony?	Yes No	If yes, please explain fully. Conviction of a crime is not an automatic bar to employment. All circumstances will be considered.
Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the attached job description]?

Previous Employment with Us

Have you worked for this company before?	Yes No	If so, where?
Dates:	to mm-dd-yyyy	Rate of Pay:
Position:		Reason for leaving

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city. state and zip code.

*Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

Previous Employer 1:
Name:	Address:
City:	State:
Zipcode:	Contact Person:
Phone Number:	Dates Employed:	to mm-dd-yyyy
Position Held:	Salary/Wage:
Reason for Leaving:	WERE YOU SUBJECT TO THE FMCSRs ** WHILE EMPLOYED?	Yes No
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?		Yes No

Previous Employer 2:
Name:	Address:
City:	State:
Zipcode:	Contact Person:
Phone Number:	Dates Employed:	to mm-dd-yyyy
Position Held:	Salary/Wage:
Reason for Leaving:	WERE YOU SUBJECT TO THE FMCSRs ** WHILE EMPLOYED?	Yes No
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?		Yes No

Previous Employer 3:
Name:	Address:
City:	State:
Zipcode:	Contact Person:
Phone Number:	Dates Employed:	to mm-dd-yyyy
Position Held:	Salary/Wage:
Reason for Leaving:	WERE YOU SUBJECT TO THE FMCSRs ** WHILE EMPLOYED?	Yes No
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?		Yes No

Previous Employer 4:
Name:	Address:
City:	State:
Zipcode:	Contact Person:
Phone Number:	Dates Employed:	to mm-dd-yyyy
Position Held:	Salary/Wage:
Reason for Leaving:	WERE YOU SUBJECT TO THE FMCSRs ** WHILE EMPLOYED?	Yes No
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?		Yes No

Previous Employer 5:
Name:	Address:
City:	State:
Zipcode:	Contact Person:
Phone Number:	Dates Employed:	to mm-dd-yyyy
Position Held:	Salary/Wage:
Reason for Leaving:	WERE YOU SUBJECT TO THE FMCSRs ** WHILE EMPLOYED?	Yes No
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?		Yes No

Previous Employer 6:
Name:	Address:
City:	State:
Zipcode:	Contact Person:
Phone Number:	Dates Employed:	to mm-dd-yyyy
Position Held:	Salary/Wage:
Reason for Leaving:	WERE YOU SUBJECT TO THE FMCSRs ** WHILE EMPLOYED?	Yes No
WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?		Yes No

* Includes vehicles having a GVWR of 26,001 Ibs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

** The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Accident Record for the Past 3 Years or More

Dates	NATURE OF ACCIDENT (HEAD-ON, REAR-END, UPSET, ETC.)	FATALITIES	INJURIES	HAZARDOUS MATERIAL SPILL



I have not had any accidents.

Traffic Convictions and Forteitures for the Past 3 Years

( Other than Parking Violations )

LOCATION	DATE	CHARGE	PENALTY



I have not had any convictions or forfeitures.

Experience and Qualifications

Driver licenses or permits held in the past 3 years

Upload Your Resume:

	State	License No.	Class	Endorsement(s)	Expiration Date:
License/Permit 1:
License/Permit 2:
License/Permit 3:
License/Permit 4:
License/Permit 5:

A: Have you ever been denied a license, permit or privilege to operate a Motor vehicle?	Yes No
B: Has any license, permit or privilege ever been suspended or revoked?	Yes No
IF THE ANSWER TO EITHER A OR B IS YES, GIVE DETAILS

Driving Experience

CLASS OF EQUIPMENT	TYPE OF EQUIPMENT	Date From	To	APPROX. NO. OF MILES (TOTAL)
STRAIGHT TRUCK
TRACTOR AND SEMI-TRAILER
TRACTOR - TWO TRAILERS
TRACTOR - THREE TRAILERS
MOTORCOACH-SCHOOLBUS More than 8 passengers
MOTORCOACH-SCHOOLBUS More than 15 passengers
Other:

LIST STATES OPERATED IN FOR LAST FIVE YEARS:		SHOW SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER:
WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM?		SHOW ANY TRUCKING, TRANSPORTATION OR OTHER EXPERIENCE THAT MAY HELP IN YOUR WORK FOR THIS COMPANY
LIST COURSES AND TRAINING OTHER THAN SHOWN ELSEWHERE IN THIS APPLICATION		LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN)

Education

HIGHEST GRADE COMPLETED:		COLLEGE
NAME OF LAST SCHOOL ATTENDED:		CITY/STATE

To be Read by Applicant

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Signature: Date: