Who referred you to this position? Enter their first and last name here.
Do you have a valid driver's license?
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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?
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If Yes, what location and when (date)?
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. * -- No answer -- No Yes
Are you at least 19 years of age?
* -- No answer -- Yes No
Do you have the legal right to work in the United 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. * -- No answer -- Yes No
Do you have a driver's license or Federal or State Issued ID?
* -- No answer -- Driver's License Federal or State Issue ID Neither
Most Recent Employer Name
Address of Employer - City and State
End Date (put today's date if still employed)
Type of Work Performed.
Reason For Leaving
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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.
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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. The law requires us to provide equal employment opportunity to qualified
people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we
must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability
or have ever had one. People can become disabled, so we need to ask this question at least every five years.
Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who
makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you
want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance
Programs (OFCCP) website at
A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had
such a condition, you are a person with a disability.
Disabilities include, but are not limited to:
Alcohol or other substance use
disorder (not currently using
Autoimmune disorder, for
example, lupus, fibromyalgia,
rheumatoid arthritis, HIV/AIDS
Blind or low vision
Cancer (past or present)
Cardiovascular or heart
Deaf or serious difficulty
Disfigurement, for example,
disfigurement caused by burns,
wounds, accidents, or congenital
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example,
Crohn's Disease, irritable bowel
Intellectual or developmental disability
Mental health conditions, for example,
depression, bipolar disorder, anxiety
disorder, schizophrenia, PTSD
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the
use of a wheelchair, scooter, walker,
leg brace(s) and/or other supports
Nervous system condition, for example,
migraine headaches, Parkinson’s
disease, multiple sclerosis (MS)
Neurodivergence, for example,
(ADHD), autism spectrum disorder,
dyslexia, dyspraxia, other learning
Partial or complete paralysis (any
Pulmonary or respiratory conditions, for
example, tuberculosis, asthma,
Short stature (dwarfism)
Traumatic brain injury
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