Columbia Elementary School District 10140 Old Oregon Trail Redding, CA 96003 Phone: 530-223-1915

PRIVATE DRIVER APPLICATION (Volunteers Driving Personal Vehicle) For School Year 2017/2018 Please print legibly. One application per person, per vehicle. Application valid for current school year only.

A.

PERSONAL USE DRIVER INSTRUCTIONS Drivers and private vehicles being operated for Columbia Elementary School District purposes must meet or exceed the follow ing guidelines: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

14.

All drivers must be approved by the school or site administrator. 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. All drivers must be cleared through Depart ment of Justice fingerprint scan. Driver must be free of any medical condition that may affect his/her ability to operate a vehicle. No alcohol or drugs w ill be consumed prior to, or w hile operating the vehicle. The vehicle w ill be in excellent condition and repair. The number of passengers shall not exceed the capacity for w hich the vehicle w as designed. No one may transport more than nine passengers plus the driver in any vehicle. All occupants must w ear seat belts w henever the vehicle is in motion. 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 safety standards. The use of cell phones, w alkmans, pagers or other electronic devices w hile driving is prohibited. Smoking a pipe, cigar or cigarette/electronic cigarette in the vehicle is prohibited. The driver accepts the added responsibility that comes from carrying extra individuals and, theref ore, w ill be conscientious in obeying all driving rules and regulations in accordance w ith federal, stat e and local law s. The California Supreme Court has eliminated the protection of the former California Guest Law ; therefore, a guest passenger may sue his/her host ow ner/driver. 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 aft er your policy limits have been exceeded.

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 . NCSIG 5/2016

Minimum liability limits of insurance required are: Bodily Injury $100,000 each person; $300,000 each occurrence Property Damage $ 50,000 each occurrence or Combined Single Limit $300,000 each occurrence 16.

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.

B.

DRIVER INFORMATION Driver Name______________________________ Date of Birth ____________________ Address__________________________________ License # ____________________ __________________________________________Expiration Date _________________ Home Phone _____________________________ Cell Phone ____________________

C.

VEHICLE INFORMATION Make & Model_____________________________ Vehicle Year ___________________ Registered Owner Name___________________ License Plate ___________________ Number of Seatbelts _______________________ Registration Expiration Date _____ Number of Booster/Child Restraint Seats, if applicable _________________

D.

INSURANCE FOR VEHICLE LISTED ABOVE Insurance Company______________________ Policy No.: _____________________ Expiration Date of Policy_________________ Bodily Injury Limit

$________________ each person $________________ each occurrence $________________ each occurrence

Property Damage Limit ~OR~ Bodily Injury and Property Damage Liability, Combined Single Limit $________________ each occurrence E.

DRIVING RECORD 1. Have you had a valid California Driver License during the past 3 years? __Yes __ No 2. Age w hen first licensed? _______ 3. Based on the Driving Record Table below , does your driving record meet the crit eria of an “ Acceptable Driver” ? __ Yes __ No

NCSIG 5/2016

Minor Violations (within past 3 Years) include any moving violation that is not a major/serious violation as show n in this Table. (Examples of minor violations include, but are not limited to speeding, failure t o yield, illegal passing, stop sign/light violation, improper turn, follow ing too close, any other moving violation w here DMV points are assessed). Number of Minor Number of At-Fault Accidents Violations Within Last 3 Years Within Last 3 Years 0 1 2 3 or more 0 Acceptable Acceptable Borderline Unacceptable 1 Acceptable Acceptable Borderline Unacceptable 2 Acceptable Borderline Unacceptable Unacceptable 3 or more Unacceptable Unacceptable Unacceptable Unacceptable License Suspension or Revocation (within past 3 Years) Major/Serious Violations (within past 5 Years) • Failure to stop in t he event of an accident (Hit and Run) • Driving under t he influence of alcohol or drugs or w ith open container • Refusing to take a substance/chemical test • More than one dismissal of a conviction relating to controlled substances • Reckless/Careless Driving • Homicide or Manslaughter or using vehicle in connection w it h a felony • Evading a Peace Officer or resisting arrest • Driving the w rong w ay or in the incorrect lane on a divided highw ay • Driving in excess of 100 mph • Racing/Speed contests • Passing a stopped school bus

F.

G.

Unacceptable Unacceptable

ATTACH

1. Copy of Driver License 2. Copy of Current Auto Insurance Policy 3.

DRIVER ACKNOWLEDGEMENT I certify the above information is correct and agree to advise the Columbia Elementary School District, in writing, of any changes in the above information. I have read and understand the Personal Use Driver Instructions. Print Driver Name Driver Signature Date __________________________

NCSIG 5/2016

H.

ACKNOWLEDGEMENT BY REGISTERED OWNER: As the registered ow ner, 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 am not driving in a capacity that requires mandatory enrollment in the EPN program pursuant to California Vehicle Code (CVC) Section 1808.1(k). 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. Print Registered Owner Name ______________________________________________ Owner’ s or Authorized Represent ative Signature _____________________________ Date ________________________

Authorized Driver’ s Name (if different from registered owner) ________________________________________________________________

For District Use Only: Approved Driver and Vehicle: ____________________________________________________ Date: ____________ (Designated District Official)

NCSIG 5/2016

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