Transportation Employment Application

 
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 District 5 Transportation Employment Application 

 
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  Select Date
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  Background Information - This information will be kept confidential. Any falsification or deliberate misrepresentation, including omission of a material fact or failure to complete any part of your application or this questionnaire can be grounds for denial of employment or termination from employment with District Five. All questions must be answered regardless of city, state or country where the offense, occurred including those outside of the United States or regardless of whether the charge has been dropped, dismissed, expunged or not prosecuted.
   
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Selling or Distributing Erotic Material or Pornography  
Malicious Harassment  
Child Molestation  
Kidnapping  
Child Buying or Selling  
Sexual Misconduct  
Prostitution  
Manslaughter  
Robbery, Burglary or Theft  
Vehicular homicide  
Driving While Intoxicated or Driving While Impaired  
First, Second or Third Degree Rape  
Rape of a Child  
Assault of a Child  
Incest  
Child Abuse or Neglect  
Indecent Liberties or Exposure  
Child Abandonment  
Assault  
Any Criminal Mistreatment  
Murder  
Careless or Reckless Driving  
   
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*Must provide description, date(s) location, charge, conviction(s) and the disposition of each arrest, charge or conviction. Applicants who have lived outside of South Carolina must provide a Department of Motor Vehicle and State Background check from the state they resided in during the last 10 years.
 
   
  Medical Background - This information will be kept confidential. Any falsification or deliberate misrepresentation, including omission of a material fact or failure to complete any part of your application or this questionnaire can be grounds for denial of employment or termination from employment with District Five. All questions must be answered. If additional space is needed, attach a separate sheet of paper.
   
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Seizures, convulsions and/or epilepsy  
Diabetes or sugar in urine  
Diabetes requiring pills or insulin  
High Blood Pressure  
Fainting  
Anxiety or mental illness  
Back Pain (Chronic or disabling)  
Depression  
Any infectious disease  
Kidney Disease or dialysis  
Spinal Injury or Disease  
Eye disorder or impaired vision  
Digestive problems  
Chronic Fatigue  
Sleep apnea or sleeping disease  
Narcolepsy  
Snoring, daytime sleepiness  
Chest Pain  
Asthma  
Amputations  
Tuberculosis or a positive TB test  
Heart Attack  
Palpitations  
Arthritis  
Nervous condition(s)  
Hearing loss or loss of balance  
Muscular Disease  
Liver Disease  
   
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Have you ever been dismissed, discharged, or fired from any employment?  
Have you ever resigned from or otherwise left any employment while allegations of misconduct on your part were pending or under investigation?  
Have you ever been disciplined by a past or present employer because of allegations of misconduct?  
Are you currently the subject of any investigation or inquiry by an employer because of allegations of misconduct or harassment on your part or have you ever been found to be guilty of misconduct or harassment by an employer?  
   
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Note: Applicants who have received five (5) traffic violations and/or three (3) at fault accidents within the last ten (10) years may not be considered for training or employment.
 
   
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The information within this application must be correct and complete. The applicant must understands that any false statement(s), misrepresentation or omission of information on this application or other required documents shall be considered sufficient cause for denial of employment or dismissal at any time regardless of when statement, misrepresentation or omission was made. AUTHORIZATION is hereby given to the school district to investigate medical records, records with prior employers, schools, police, law enforcement agencies, FBI and driving record now or at any time during employment. Applicant also consents to be tested for drugs and for alcohol at the discretion of the school district and understands that a positive test result or refusal to be tested will be cause for dismissal. UNDER PENALTY OF PERJURY, I certify that the above information is true, correct and complete. I understand that if I am hired, I can be discharged for any misrepresentation or omission in the above statement. I understand that if I am hired, my employment is conditional based on your receipt of a satisfactory report(s) from any or all law enforcement agencies or other sources. I also understand that I may be dismissal from employment if, at any time, information on this application is found to be false, misleading or in any way a misrepresentation of the facts or of the information I have provided. I hereby release all sources from any and all liability. My electronic signature below certifies that the above information is true, correct and complete.
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