P.R.I.D.E. Personal Job Profile 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 InformationName* First Last Email* Title*Official Company Name:*Company Phone*Cell PhoneCompany FaxSpecial RequirementsSpecial 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 AddressCompany Address*City*Postal Code*Province*Contact Information Consent*YesNoDo you want your contact information to appear on the registrant list for networking amongst course attendees and master trainers participating in your program?Work HistoryNumber of years with present organization:*Number of years in present position:*Number of years in transportation industry:*Span of ControlTotal 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?*YesNoPlease specify the programs taken* DO YOU HAVE EXPERIENCE DRIVING A SCHOOL BUS*YesNo# 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 experienceSpecify size of Special Needs School Bus* DO YOU HAVE EXPERIENCE DRIVING A TRANSIT VEHICLE*YesNo# 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 experienceSpecify Size of Para Transit/Special Needs Bus* DO YOU HAVE EXPERIENCE DRIVING A HIGHWAY COACH*YesNo# of years of on-road experience DO YOU HAVE EXPERIENCE DRIVING OTHER (eg. HEAVY EQUIPMENT, TRANSPORT TRUCK, ETC.)*YesNo# of years of on-road experience* HAVE YOU PREVIOUSLY BEEN AN ON-BOARD INSTRUCTOR FOR SCHOOL BUS:*YesNoPlease Specify Size* HAVE YOU PREVIOUSLY BEEN AN ON-BOARD INSTRUCTOR FOR HIGHWAY COACH*YesNoPlease Specify Size* HAVE YOU PREVIOUSLY BEEN AN ON-BOARD INSTRUCTOR FOR TRANSIT VEHICLE*YesNoSpecify size* HAVE YOU PREVIOUSLY BEEN AN ON-BOARD INSTRUCTOR FOR OTHER (eg. HEAVY EQUIPMENT, TRANSPORT TRUCK, ETC.)*YesNospecify 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)LicenseLicence 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