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IMPORTANT INFORMATION FOR APPLICANTS PLEASE READ CAREFULLY

Applicants are advised that if any information provided in this Application for Employment by the Applicant is determined to be false as a result of the Company's screening process, to include fingerprinting and criminal background checks, the Applicant shall no longer be considered for employment. Further, should any Applicant that the Company hires is subsequently found to have provided false information when completing the Application, this shall serve as grounds for the Employee's immediate dismissal from employment by the Company.

Applicant s are also hereby advised that when completing the Application question concerning convictions for criminal offenses, that the criminal background checks conducted by the Company include otherwise sealed criminal records. Despite provisions under Ohio Revised Code that permit sealing (also called "expungement") of criminal records, some employers are exceptions and are allowed under Ohio Revised Code to receive and review otherwise sealed criminal history when completing background checks. Such employers include schools. Because the Company serves schools and employs individuals for positions such as school bus drivers who have direct contact with minors, the Company is held to the same standards and requirements as the State of Ohio holds the schools when hiring. Additionally, the Company has the same exception as to receiving and reviewing sealed criminal records extended to it as the schools do under law.

ABOUT US

Community Bus Services (CBS) is a leading provider of transportation services to school districts, non-profit organizations and communities, founded in 1933 by James F. Thomas. CBS continues today as a locally owned family company, primarily doing business in northeastern and central Ohio and has expanded services to include transportation for those with special needs and the medically frail. CBS has an impeccable reputation for quality drivers held to the highest standards of safety and care for the people they move. BusTeam is a division of CBS.

EMPLOYMENT APPLICATION

PERSONAL INFORMATION

First Name:*

Last Name:*

MI

Primary Phone:*

Other Phone:

Address Line 1:*

Address Line 2:

City:*

State:*

Zip code:*

Do you have an e-mail Account?*

Yes No

Have you ever had a Non-Ohio drivers license?*

Yes No

If Yes, Please note those States below...

Do you have a current Commercial Drivers License (CDL)?*

Yes No

If Yes, Please note endorsements below...

What position are you applying for?*

Yes No

Have you ever applied or worked here before?*

If Yes, Please list date(s) and or position(s)

How did you learn of this position and or were you referred by a current employee?

If hired, can you present evidence of your US Citizenship or proof of your legal right to live

Yes No

and work in this Country?*

Have you ever been convicted of a crime?

Yes No

If Yes, Please provide dates and details below...

(NO APPLICANT WILL BE DENIED EMPLOYMENT SOLELY ON THE GROUNDS OF CONVICTION OF A CRIMINAL OFFENSE. THE NATURE OF THE OFFENSE, DATE OF OFFENSE, SURROUNDING CIRCUMSTANCES, REHABILITATION AND RELEVANCE OF THE OFFENSE TO THE POSITION(S) APPLIED FOR MAY, HOWEVER, BE CONSIDERED. (PLEASE NOTE: IN THE STATE OF OHIO A FEW POTENTIAL EMPLOYERS, SUCH AS POLICE DEPARTMENTS, CHILD CARE PROVIDERS, SCHOOLS, AND NURSING HOMES, WILL BE ABLE TO SEE YOUR SEALED RECORD. THE EXCEPTION APPLIES TO OUR COMPANY JUST AS IT DOES THE SCHOOL SYSTEMS WE SERVE.

Have you ever been convicted of a alcohol or drug offense?*

YesNo

Have you ever been convicted of a DUI?*

Yes No

lf "yes", please provide date(s) and details below:

EDUCATION

Location (City, State)

Name of School

Graduated?

High School

College

Trade School

EMPLOYMENT HISTORY

APPLICANTS THAT WERE PREVIOUSLY EMPLOYED AS A DRIVER OF A COMMERCIAL VEHICLE MUST PROVIDE TEN YEARS OF EMPLOYMENT HISTORY IN WHICH THEY WERE A CDL DRIVER:

Last Employer

Previous Employer

Job Title

Address

City, State ZIP

Dates of Employment (From / To)

Supervisor Name

Phone Number

Job Duties

Reason for Leaving?

Pay Rate

Pay Rate Type

DOT Drug and Alcohol Testing?

May we contact this employer?

REFERENCES (You must provide 3 references below)

A NAME	B TELEPHONE	C YEARS ACQUAINTED	D OCCUPATION

Community Bus Services/BusTeam Applicant Acknowledgement and Signature
READ EACH SECTION CAREFULLY AND PLACE A CHECK MARK TO THE LEFT OF EACH STATEMENT TO INDICATE YOUR ACKNOWLEDGEMENT AND SIGNATURE.

*

Read / Check Here

I HEREBY CERTIFY THAT I HAVE NOT KNOWINGLY WITHHELD ANY INFORMATION THAT MIGHT ADVERSELY AFFECT MY CHANCES FOR EMPLOYMENT AND THAT THE ANSWERS GIVEN BY ME ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I FURTHER CERTIFY THAT I, THE UNDERSIGNED APPLICANT, HAVE PERSONALLY COMPLETED THIS APPLICATION. I UNDERSTAND THAT ANY OMISSION OR MISSTATEMENT OF MATERIAL FACT ON THIS APPLICATION OR ON ANY DOCUMENT USED TO SECURE EMPLOYMENT SHALL BE GROUNDS FOR REJECTION OF THIS APPLICATION OR FOR IMMEDIATE DISCHARGE IF I AM EMPLOYED REGARDLESS OF THE TIME LAPSED BEFORE DISCOVERY.

I HEREBY AUTHORIZE THOROUGH INVESTIGATION OF MY REFERENCES, WORK RECORD, EDUCATION, AND OTHER MATTERS RELATED TO BY SUITABILITY FOR EMPLOYMENT, AND FURTHER, AUTHORIZE THE REFERENCES I HAVE LISTED TO DISCLOSE TO THE COMPANY ALL LETTERS, REPORTS, AND OTHER INFORMATION RELATED TO MY WORK RECO RDS, WITHOUT GIVING ME PRIOR NOTICE OF DISCLOSURE. IN ADDITION, I HEREBY RELEASE THE COMPANY, MY FORMER EMPLOYERS, AND ALL OTHER PERSONS , CORPORATIONS PARTNERSHIPS AND ASSOCIATIONS FROM ANY AND ALL CLAIMS, DEMANDS, OR LIABILITIES RISING OUT OF OR IN ANY WAY RELATED TO SUCH INVESTIGATION OR DISCLOSURE.

*

Read / Check Here

*

Read / Check Here

I UNDERSTAND THAT NOTHING CONTAINED IN THE APPLICATION, OR CONVEYED DURING ANY INTERVIEW THAT MAY BE GRANTED OR DURING MY EMPLOYMENT, IF HIRED, IS INTENDED TO CREATE AN EMPLOYMENT CONTRACT BETWEEN THE COMPANY AND ME. IN ADDITION, I UNDERSTAND AND AGREE THAT IF I AM EMPLOYED, MY EMPLOYMENT IS FOR NO DEFINITE OR DETERMINABLE PERIOD AND MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT PRIOR NOTICE, AT THE OPTION OF EITHER MYSELF OR THE COMPANY, AND THAT NO PROMISES OR REPRESENTATIONS CONTRARY TO THE FOREGOING ARE BINDING ON THE COMPANY UNLESS MADE IN WRITING AND SIGNED BY THE COMPANY REPRESENTATIVE AND ME.

*

Read / Check Here

I UNDERSTAND THAT THIS EMPLOYER DOES NOT UNLAWFULLY DISCRIMINATE IN EMPLOYMENT AND NO QUESTION ON THIS APPLICATION IS USED FOR THE PURPOSE OF LIMITING OR ELIMINATING ANY APPLICANT FROM CONSIDERATION FOR EMPLOYMENT ON A BASIS PROHIBITED BY APPLICABLE LOCAL, STATE OR FEDERAL LAW.

*

Read / Check here

I UNDERSTAND THAT THIS APPLICATION REMAINS CURRENT FOR ONLY 30 DAYS. AT THE CONCLUSION OF THAT TIME, IF I HAVE NOT HEARD BACK FROM THE EMPLOYER AND STILL WISH TO BE CONSIDERED FOR EMPLOYMENT, IT WILL BE NECESSARY TO REAPPLY AND FILL OUT A NEW APPLICATION.

*

Read / Check Here

I UNDERSTAND THAT IN CONJUNCTION WITH MY POTENTIAL EMPLOYMENT, I CONSENT TO THE RELEASE OF MY MOTOR VEHICLE RECORDS (MVR) TO THE COMPANY, AND FURTHER UNDERSTAND THE COMPANY WILL USE THESE RECORDS TO EVALUATE MY SUITABILITY TO FULFILL DRIVING DUTIES THAT MAY BE RELATED TO THE POSITION FOR WHICH I AM APPLYING.

INFORMED CONSENT
Background Investigation Permission and Drug & Alcohol Testing

I, the undersigned applicant of Community Bus Services/BusTeam, residing at below stated address, have been advised and am fully aware that representatives of the above named company will be conducting a thorough investigation of my background to assist in determining my suitability for this employment, including making inquiries of: officials and records at schools which I attend; physicians and/ or other persons who may have examined or treated me for a ph ysical or other type of illness or injury; police or courts with who I may have an arrest or conviction record; present and previous emplo yers; other persons who may be able to provide information about me which the company desires; criminal background check with both Ohio BCI and FBI; and driving record from Ohio Bureau of Motor Vehicles. All of these inquiries are with my consent.

I hereby give my per mission and waive all provisions of law forbidding any ph ysician or other person who has attended me, or any other school officials, court, government or police agency, employer, form or person, from disclosing any knowledge or in formation they have concerning me which is reque sted or desired by the above named company. I further consent that the Superintendent or his / her representative be provided with a copy of such record concerning me, which they may desire.

I recognize the right of Community Bus Services/ BusTeam and the Board of Education, to treat at its discretion, certain sources as confidential, and its right to withhold from my agent or me the names of such confidential sources, and information obtained there from.

In addition, as an applicant of the company, I here by acknowledge that the company's policy requires me to submit to urine drug testing and/ or breath, saliva, or blood alcohol testing. I further understand the purpose of this analysis is to determine or rule out the presence of non-prescribed or prohibited dangerous controlled substances in my system.

I hereby freely and voluntarily con sent to this request for a urine sample and / or breath, saliva, or blood alcohol test, and agree to participat e in the testing program.

I hereby and herewith release the company, its employees, agents, and contractors from any and all liability whatsoever arising from this request for testing, from the actual testing procedures and from decisions made concerning my application for or continuation of employment based on the results of the analysis.

I agree to cooperate in all aspects of the testing program and hereby authorize the release of my drug and/or alcohol test results to the contractor's medical review officer, and/or the company's examining physician, as provided by the Policy.

I further acknowledge the company has pro vided m e with an opportunity to ask questions related to its drug and alcohol testing program, and it answered all my questions.

Signature

Type your Full Name Here to Sign*

TRAINING POLICY STATEMENT

BusTeam puts a great deal of investment of both time and money into the training of our drivers. As such, unlike other employers who require that drivers already are licensed to drive school bus in the State of Ohio at the time of hire, or who place the burden of paying for such training needed to drive school bus in the State of Ohio entirely on the newly hired employee, BusTeam instead pays for newly hired drivers to receive such a benefit at our cost. However, in the event that a driver chooses to leave employment prior to having completed twenty-six (26) working weeks of employment with BusTeam after receipt of certification, that employee will be assessed a cost of one thousand two hundred fifty dollars ($1,250.00), deducted from the employee's final paycheck from BusTeam. If the amount available from the final paycheck is insufficient to cover this full amount due, BusTeam shall take all legally available steps as may prove necessary to collect not only the outstanding debt due from the employee for the training BusTeam has provided, but also the costs of collection incurred by BusTeam.

I have read and understand the above policy statement concerning the costs incurred by my employer for the training I am being provided by my employer, and I understand that in the event that I should voluntarily terminate my employment prior to the period of time described therein, I agree that I am responsible for reimbursing my employer the total cost of that training as stated therein.

Signature

Type your Full Name Here to Sign*

BCl&I Fingerprint Authorization & Release Form

I, the undersigned applicant/employee certify that the personal identifiers provided on this form are accurate and I voluntarily and knowingly authorize Community Bus Services/BusTeam webcheck agency to submit information to the Ohio Bureau of Criminal Identification and Investigation (BCI&I) to conduct a criminal records check for information relating to me.

I voluntarily and knowingly authorize BCI&I to disseminate criminal arrest, conviction and juvenile delinquenc y adjudication record s to the webcheck provider or agency have designated to receive this information. I voluntarily and knowingly release and discharge the Ohio Attorney General's Office, BCI&I and their employees from claims and liability related to this authorization criminal records review and dissemination.

This authorization and waiver is valid for one year from the date this background check was conducted.

Signature

Type your Full Name Here to Sign*

School Bus Driver
FMCSA Drug and Alcohol Background Check Form
Applicant History Sheet

Federal Motor Carrier Safety Administration regulations (49 CFR Part 40) require employers to inquire about the following information on an employee from the employee 's previous employers during the two years immediately preceding the employee's date of applicatio n. This requirement applies only to employees seeking to begin performing safety-sensitive duties for the first time. The employer must obtain the employee's written consent to request this information. As an app licant/employee , you may refuse to provide this written consen t, however the employer is not permitted to use the employee to perform safety-sensitive functions.

The information which must be requested is as follows:
(1) Alcohol tests with a result of 0.04 or higher alcohol concentration;
(2) Verified positive drug tests;
(3) Refusals to be tested (including verified adulterated or substituted drug test results) ; ( 4) Other violations of DOT agency drug and alcohol testing regulations ; and
(5) With respect to any employee who violated a DOT drug and alcohol regulation, documentation of the employee's successful completion of DOT return-to-duty requirements (including follow-up tests).
The information obtained must be held confidential , and must be retained for three years from the date of the employee's first performance of safety-sensitive functions.

The employer must also ask the employee whether he or she has tested positive, or refused to test, on any pre employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol test rules during the past two years .

Have you applied, but not been hired by any employers in the past two years who required a

DOT drug and Alcohol test?*

Yes No

If Yes, on any of these tests, did you test positive or refuse to test?*

Yes No

Bureau of Motor Vehicles Consent Form

Community Bus Services requires all applicants to provide necessary data that will allow the completion of a Bureau of Motor Vehicles (BMV) Report. Do you consent to provide this information...?

Yes, I will provide the required data to allow this report.

No, I do not agree to provide this data.

We appreciate your interest in joining our team! At this time, we are unable to further process your application for employment. Thank you for your consideration.

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Issuing State:*

Social Security #*

Date of Birth*

Drivers License #*

Please attach a photo or copy of the front of your Operators License.

Please attach a photo or copy of the back of your Operators License.

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