Driver Data Form (Confidential) Personal Data Name ________________________________________ Address _____________________________________ _____________________________________________ Home phone (_____) ___________________________ Emergency phone (_____) _______________________ Additional Personal Data Number children in district: _______ Now _______ Past _______ Grandchildren List family members employed by the Board (Name, position, & location): _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ List organizations of which you are a member: _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ List relatives or friends who are community leaders (political/business/civic) _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ 100 – AR Handbook List any talents/hobbies/special abilities: _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Work Data: District resident? Yes No Total yrs. driving bus: _________ for district: ________ Number of accumulated sick days _________________ Years in pension plan ___________________________ Emergency response availability: 10 min. 20 min. 30 min. Hours worked/day: _____ / _____ Hourly rate _______ Package hours: 2 4 5 6 8 Rt. # ________________________________________ Packages : Elementary Middle High Vocational Shuttle Spec. Ed Other ________________________________________ Time: start ________ (am/pm): end ________ (am/pm) Actual driving time (include layovers): ______________ Actual working hours per week: __________________ Average hours/month for Emergency/OT: __________ Assigned pupils per package: _____ Elementary _____ Middle _____ High _____ Vocational _____ Shuttle _____ Spec. Ed Other ________________________________________ Summer work hrs. _________ Amt. paid ___________ Extra runs daily: (i.e. Kindergarten/late) ____________ # of Students _________ Amt. Paid ________________ Check here if using another sheet for additional information that you feel is pertinent.
20333FG
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