P.R.I.D.E. Personal Job Profile – School Bus Ontario

Instructions: Please fill out all the fields and click on the Submit button at the bottom of the form.

Name for name badge:*

Name on certificate:*

Contact Information

Name*

First Last

Email*

Title*

Official Company Name:*

Company Phone*

Cell Phone

Company Fax

Special Requirements

Special Requirements (e.g. dietary, transportation, health, other) – For specific dietary/health requirements, include all details and specific food preferences. If details not provided in advance on this form, dietary arrangements with the caterer will not be made:

Supervisor Name:*

Supervisor Cell:

Supervisors Email*

Emergency Contact Name:*

Emergency Contact Phone*

Company Address

Company Address*

City*

Postal Code*

Province*

Contact Information Consent*

Yes
No

Do you want your contact information to appear on the registrant list for networking amongst course attendees and master trainers participating in your program?

Work History

Number of years with present organization:*

Number of years in present position:*

Number of years in transportation industry:*

Span of Control

Total number of employees you are responsible for:*

Total number of employees reporting directly to you:*

Please indicate the average number of employees over a one year period in your organization (Includes full and part-time employees):*

Please list the major responsibilities of your position.*

HAVE YOU TAKEN ANY OTHER “TRAIN-THE-TRAINER” TYPE PROGRAMS BEFORE?*

Yes
No

Please specify the programs taken*

DO YOU HAVE EXPERIENCE DRIVING A SCHOOL BUS*

Yes
No

# of years of on-road experience in 72 Passenger Bus*

enter 0 for no experience

# of years of on-road experience in Van*

enter 0 for no experience

# of years of on-road experience in Special Needs School Bus*

enter 0 for no experience

Specify size of Special Needs School Bus*

DO YOU HAVE EXPERIENCE DRIVING A TRANSIT VEHICLE*

Yes
No

# of years of on-road experience on 40ft Transit Vehicle:*

enter 0 for no experience

# of years of on-road experience on 35ft Transit Vehicle:*

enter 0 for no experience

# of years of on-road experience on 30ft Transit Vehicle:*

enter 0 for no experience

# of years of on-road experience on Para Transit/Special Needs:*

enter 0 for no experience

Specify Size of Para Transit/Special Needs Bus*

DO YOU HAVE EXPERIENCE DRIVING A HIGHWAY COACH*

Yes
No

# of years of on-road experience

DO YOU HAVE EXPERIENCE DRIVING OTHER (eg. HEAVY EQUIPMENT, TRANSPORT TRUCK, ETC.)*

Yes
No

# of years of on-road experience*

HAVE YOU PREVIOUSLY BEEN AN ON-BOARD INSTRUCTOR FOR SCHOOL BUS:*

Yes
No

Please Specify Size*

HAVE YOU PREVIOUSLY BEEN AN ON-BOARD INSTRUCTOR FOR HIGHWAY COACH*

Yes
No

Please Specify Size*

HAVE YOU PREVIOUSLY BEEN AN ON-BOARD INSTRUCTOR FOR TRANSIT VEHICLE*

Yes
No

Specify size*

HAVE YOU PREVIOUSLY BEEN AN ON-BOARD INSTRUCTOR FOR OTHER (eg. HEAVY EQUIPMENT, TRANSPORT TRUCK, ETC.)*

Yes
No

specify size:*

WHEN YOU RETURN TO YOUR COMPANY AFTER ATTENDING THIS PROGRAM, WHAT VEHICLES WILL YOU BE AN ON-BOARD INSTRUCTOR FOR?*

School Bus
Highway Coach
Transit Vehicle
Special Needs Vehicle
Other

Specify Other*

please specify eg. transport truck, ambulance, fire truck, heavy equipment, etc.

FOR MINISTRY OF TRANSPORTATION AND INSURANCE PURPOSES, PLEASE INDICATE YOUR DRIVER’S LICENCE NUMBER (Ontario residents only)

License

Licence Class:

Number of years you have held your class of Licence:

I have acknowledged and can demonstrate competency and compliance with the Highway Traffic Act (HTA) in relation to general vehicle driving and the bus industry.

Yes
No