EMPLOYEE DRIVER APPLICATION (Part 1) For School Year 2017/2018 Site/Department: _________________________Driver Name __________________________________ District Requirements Columbia Elementary School District acknow ledges the need f or responsible drivers to provide transportation services for school activities and related business. To ensure that transportation services w ill be provided in a saf e, efficient and cost effective manner, all drivers must comply w ith the follow ing requirements: 1.

The driver must be at least age 21 to drive for business purposes and age 25 if transporting students, possessing a valid California driver’ s license, and have been continuously licensed for a minimum of 3 years. 2. Driver must be free of any medical condition that may affect his/her ability to operate a vehicle. 3. No alcohol or drugs w ill be consumed prior to, or w hile operating the vehicle. 4. The number of passengers shall not exceed the capacity for w hich the vehicle w as designed. 5. No one may transport more than nine passengers plus the driver in any vehicle. 6. Transportation is limited to District business and/or transportation of students and approved chaperones for educationally based activities, sports and field trips. 7. All occupants must w ear seat belts whenever the vehicle is in motion. 8. All students w ho are less than 8 years of age or under 4” 9” tall must be properly secured in a rear seat in a child passenger restraint system meeting applicable federal motor vehicle saf ety standards. 9. The use of cell phones, w alkmans, pagers or other electronic devices while driving is prohibited. 10. Smoking a pipe, cigar or cigarette/electronic cigarette in the vehicle is prohibited. 11. The driver accepts the added responsibility that comes from carrying extra individuals and, therefore, w ill be conscientious in obeying all driving rules and regulations in accordance w ith federal, state and local law s. The California Supreme Court has eliminated the protect ion of the former California Guest Law ; therefore, a guest passenger may sue his/her host ow ner/driver. 12. If the above conditions change and/or cannot be met, I w ill no longer participat e as a driver until the requirements can be met.

I CERTIFY THAT I HAVE READ THE ABOVE REQUIREMENTS AND THAT I AM IN COMPLIANCE WITH THEM. Signature: Name (Print):__________________________________Date:______________________________________ Address: ___________________________________Driver License #:_____________________________ ___________________________________ License Expiration Date: _____________________ Home Phone:_______________________________ Cell Phone #:_________________________________ NCSIG 5/2016

ATTACH: 1. Copy of California Driver License. 2. Part 2 of application including evidence of insurance if driving an employee owned vehicle. As the registered owner, I certify the above insurance information is correct. I understand I must have liability insurance coverage in force and agree to advise the Columbia Elementary School District, in writing, of any changes in the above information. I further certify that to the best of my knowledge, the above vehicle is mechanically safe. If an accident occurs, my auto liability policy is primary and used first for losses or claims for damage. The Columbia Elementary School District does not cover, nor is it responsible for, comprehensive and collision (physical damage) coverage to my vehicle. By signing this application, I hereby authorize the California Department of Motor Vehicles (DMV) to disclose or otherwise make available, my driving record to Columbia Elementary School District. I understand that CESD may enroll me in the Employer Pull Notice (EPN) program to receive a driver record report at least once every twelve (12) months or when any subsequent conviction, failure to appear, accident, driver’s license suspension, revocation, or any other action is taken against my driving privilege during my employment. I understand that enrollment in the EPN program is in an effort to promote driver safety, and that my driver license report will be released to CESD to determine my eligibility as a licensed driver for my employment or transporting students. Signature: __________________________________________ Name(Print):________________________________________Date:_____________________

SUBM I T AP P LICATI ON TO DI STR I CT OFFI CE AP P ROVAL P R OCESS R EQUIRES UP TO 45 DAYS. YOU MUST SUBMIT COPIES OF YOUR DRIVER LICENSE, REGISTRATION, AND INSURANCE POLICY .

For District Use Only: Approved Driver _____________________________________________________________ Date: ____________ (Designated District Official) Retain original signed form in school file aft er approval. NCSIG 5/2016

EMPLOYEE DRIVER APPLICATION (Part 2)

Required for employees using their private vehicle for business purposes. For School Year 2017/2018 Site/Department: ______________________Driver Name _____________________________

VEHICLE INFORMATION: Name of Ow ner: _____________________________________ Address: _____________________________________ _____________________________________ Telephone: _____________________________________

Description of Auto Year: ____________ Make: ___________

Number of Seatbelts:_______________ License Plat e No.: _________________ Registration Expiration: ______________ Number of Booster/Child Restraint Seats, if applicable _________________ INSURANCE INFORMATION: Driver must have an automobile liability insurance policy and assume all responsibility for all physical damage to the vehicle. When driving a personal vehicle w hile on Columbia Element ary School District business and involved in an accident, by law your liability insurance policy is used first. The Columbia Elementary School District liability policy w ould be used only after your policy limits have been exceeded. The Columbia Elementary School District does not cover, nor is it responsible for comprehensive and/or collision coverage to your vehicle. Minimum Personal Automobile Liability Limits Required: Bodily Injury

$100,000 each person $300,000 each occurrence Property Damage $ 50,000 each occurrence

OR

Combined Single Limit

$300,000 each occurrence

Auto Insurance Company: ________________________Policy No.: _____________________ Expiration Date of Policy: ________________________ Liability Limits:

Bodily Injury:

$________________ each person $________________ each occurrence Propert y Damage: $________________ each occurrence ~OR~ Bodily Injury and Property Damage Liability, Combined Single Limit $________________ each occurrence

As the registered owner, I certify the above insurance information is correct. I understand I must have liability insurance coverage in force and agree to advise the Columbia Elementary School District, in writing, of any changes in the above information. I further certify that to the best of my knowledge, the above vehicle is mechanically safe. If an accident occurs, my auto liability policy is primary and used first for losses or claims for damage. The Columbia Elementary School District does not cover, nor is it responsible for, comprehensive and collision (physical damage) coverage to my vehicle. By signing this application, I hereby authorize the California Department of Motor Vehicles (DMV) to disclose or otherwise make available, my driving record to Columbia Elementary School District. I understand that CESD may enroll me in the Employer Pull Notice (EPN) program to receive a driver record report at least once every twelve (12) months or when any subsequent conviction, failure to appear, accident, driver’s license suspension, revocation, or any other action is taken against my driving privilege during my employment. I understand that enrollment in the EPN program is in an effort to promote driver safety, and that my driver license report will be released to CESD to determine my eligibility as a licensed driver for my employment or transporting students. Signature: __________________________________________ Name(Print):________________________________________Date:________________________

SUBM I T AP P LI CATI ON TO DI STR I CT OFFI CE AP P ROVAL P R OCESS R EQUIRES UP TO 45 DAYS. YOU MUST SUBMIT COPIES OF YOUR DRIVER LICENSE, REGISTRATION, AND INSURANCE POLICY .

For District Use Only: Approved Driver and Vehicle:______________________________________________________ Date: ____________ (Designat ed District Official)

Retain original signed form in District file aft er approval. Business and Noninstructional Operations

E(2) 3541.1

TRANSPORTATION FOR SCHOOL-RELATED TRIPS

DRIVER INSTRUCTIONS When using your vehicle to transport students on field trips or other school activity trips: 1.

Be sure that you have registered with the district for such purposes and have a valid driver's license and current liability insurance at or above the minimum amount required by law for each occurrence.

2.

Check the safety of your vehicle: tires, brakes, lights, horn, suspension, etc.

3.

Carry only the number of passengers for which your vehicle was designed. If you have a pickup truck, carry only as many as can safely sit in the passenger compartment.

4.

Require each passenger to use an appropriate child passenger restraint system (child car seat or booster seat) or safety belt in accordance with law.

5.

Do not smoke a pipe, cigar, or cigarette/electronic cigarette while there are minors in the vehicle, as required by law.

6.

Obey all traffic laws.

7.

Take the most direct route to the destination or event without unnecessary stops.

In case of emergency, keep all students together and call 911 and the district office.

Exhibit version: January 16, 2007 Revised: June 18, 2013 Revised: April 18, 2017

COLUMBIA ELEMENTARY SCHOOL DISTRICT Redding, California