Who referred you to this position? Enter their first and last name here.
Do you have a valid driver's license?
* No answer Yes No
Do you have a valid Commercial Driver's License?
* No answer Yes No
What's your highest level of education completed?
* No answer GED or Equivalent High School Some College College - Associates College - Bachelor of Arts College - Bachelor of Fine Arts College - Bachelor of Science College - Master of Arts College - Master of Science College - Master of Fine Arts College - Master of Business Administration College - Doctorate Medical Doctor Other
Earliest start date?
Have you worked for Birnie Bus before?
* Yes No
If Yes, what location and when?
Where did you hear about us?
* -- No answer -- Internet Career Page Radio Flyer Road Sign Banner Dept. of Labor Employee Referral Job Fair Other
As part of the employment process, you will be required to pass a physical performance test, which includes dragging an object weighing 125 lbs. and other emergency skills.
Check "Yes" if you are able to perform these functions.
Check "No" if there is any reason you might be unable to perform these functions of the job for which you have applied.
No applicant will be automatically disqualified from consideration based on physical skills alone, unless they have a bearing on the particular job applying for. * Yes No
Are you at least 21 years of age?
* Yes No
Do you have the legal right to work in the Unites States?
If hired, you will be required by law to complete a Form I-9 for Employment Eligibility Verification. Birnie Bus Service also participates in E-Verify. * Yes No
Driver's License, what Class License do you hold?
* -- No answer -- A B C D E Other
If you have a CDL, what endorsements do you have?
Most Recent Employer Name
Address of Employer - City and State
End Date - put today's date if still working
Type of Work Performed.
Reason for Leaving:
Do you give us permission to text message you?
* Yes No
Pre-employment Drug Screen: As prescribed by federal and state laws or as require by contract, I understand that as a condition of my employment, a pre-employment drug screen will be required only if and after a contingent offer of employment is extended for which a negative result must be received prior to the first day of employment.
* I acknowledge and understand the requirement I do not understand the requirement
The following questions are entirely optional.
To comply with government Equal Employment Opportunity and/or Affirmative Action reporting regulations, we are requesting (but NOT requiring) that you enter this personal data. This information will not be used in connection with any employment decisions, and will be used solely as permitted by state and federal law. Your voluntary cooperation would be appreciated.
Decline to answer Female Male
Decline to answer Hispanic or Latino White, not Hispanic or Latino Black or African-American, not Hispanic or Latino Asian, not Hispanic or Latino Native Hawaiian or Other Pacific Islander, not Hispanic or Latino American Indian or Alaskan Native, not Hispanic or Latino Two or More Races, not Hispanic or Latino
Invitation for Job Applicants to Self-Identify as a U.S. Veteran
A “disabled veteran” is one of the following:
a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
a person who was discharged or released from active duty because of a service-connected disability.
A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Voluntary Self-Identification of Disability
Voluntary Self-Identification of Disability Form CC-305
OMB Control Number 1250-0005
We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability.
Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.
Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past.
For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
Blind or low vision
Cardiovascular or heart disease
Deaf or hard of hearing
Depression or anxiety
Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome
Missing limbs or partially missing limbs
Nervous system condition for example, migraine headaches, Parkinson's disease, or Multiple sclerosis (MS)
Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression
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