Bus Driver Application Driver Application Name First Last Position Applying For Bus Driver Cell PhonePhoneSocial Security NumberEnter SSN with no dashes or spaces.Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Current Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Address 1 Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Address 2 Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Additional AddressesExperience Have you ever held a school bus license?* Yes No Do you currently hold a Minnesota school bus license?* Yes No Traffic ViolationsDate (MM/DD/YY)LocationChargeType of Vehicle Traffic Violations in the last 3 years. AccidentsDate (MM/DD/YY)LocationChargeType of Vehicle Accidents in the last 3 yearsDrivers LicenseState of LicenseLicense #Exp. Date Drivers licenses held in last three yearsHas your license ever been suspended or revoked? No Yes For what reason? If yes, when? MM slash DD slash YYYY Have you ever been convicted of a felony? No Yes If yes, when? MM slash DD slash YYYY For what reason? Highest education level completed Are you a U.S. Citizen?YesNoIf foreign national, co you have a green card?YesNoEmployment History Minimum of 3 years of employment needed. Please list employer names and positions.Authorization* I accept the terms below I DO NOT accept the terms below This certifies that I completed this application and that all entries are true and complete to the best of my knowledge. Any false, misleading or incomplete statements shall be sufficient grounds for immediate termination of employment. I understand that this information may be used to contact prior employers for purposes of investigation as required by Section 391.23 of the Federal Motor Carrier Safety Regulations. Also in accordance with Section(s) 382, 383, 405, and 413, I authorize any and all persons and/or institutions to provide any relevant information, including my alcohol and controlled substances testing/training, that may be required to complete my qualification and I agree to release them from any and all liability for supplying said information. This application in no way obligates Hutch Bus to offer the applicant employment. By clicking the "Submit Application" button, I agree to these terms and wish to be considered for employment by Hutch Bus. I have the right to make a request to DAC or other past employers upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information and the recipients of any reports on me which DAC or other employers have previously furnished within the three (3) year period preceding my request. I hereby consent to Hutch Bus obtaining the above information from DAC and previous employers, and I agree that such information--which DAC or previous employers have or obtain, and as will be generated during my employment history with U.S. Xpress, Inc. if I am given safety clearance--will be supplied by DAC to other companies which subscribe to DAC Services. This consent is ongoing and open-ended. Hutch Bus has my consent to conduct this investigation and any future investigation they deem appropriate and necessary. I have the right to request and receive a printed copy of this consent form. I also have the right to retract my consent and stop all investigations previously authorized. I understand I can mail a letter to Hutch Bus, Recruiting Department, 102 N Gorman Avenue, Litchfield, MN 55355 to obtain the copy or to terminate the investigations I am authorizing. Please print the 3 attachment releases, sign and fax to 320-693-8180 or e-mail mike.hicks@hickstruckingcompany.com. Your application cannot be processed without these releases! I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC TO FURNISH THE ABOVE-MENTIONED INFORMATION. CHECKING THE FOLLOWING BOX AND SUBMITTING THIS APPLICATION MEANS THAT I HAVE READ AND AGREED TO THESE TERMS. I agree to these terms.
