VOLUNTEER DRIVER FORM 1.

Driver

Name of Driver:_______________________ Date of birth: Address:

______________

_______________________________________________________ _______________________________________________________

Phone number: ____________________________________________________ Drivers License #: ________________________ 2.

State Issued: ____________

Vehicle

Name, address and phone number of owner if different from the information above: __________________________________________________________________ __________________________________________________________________ Year, Make & Model of Vehicle: _______________________________________ License plate: ____________ Registration expiration date: _________________ Inspection expiration date: _____________________ If more than one vehicle is to be used, requested information must be provided for each vehicle. 3. Insurance – please provide the following if driving your personal vehicle on behalf of the Diocese. Insurance Company’s Name: ___________________________________________ Policy number: _________________

Expiration date:___________________

Liability Limits: _____________________________________________________ (Minimum Limits of $100,000/$300,000 Required) Appendix B (page 1 of 2)

In order to provide for the safety of those we serve, we must ask each volunteer to answer the following questions: TRUE FALSE 1. I have NOT had a conviction for an infraction involving drugs or alcohol (such as driving under the influence or driving while intoxicated) in the last three years.

______

______

2. I have NOT had two or more convictions for an infraction involving drug or alcohol (such as driving under the influence or driving while intoxicated) in the last seven years. ______

______

3. I have had no more than three moving violations or accidents in the last three years.

______

______

Please be aware that as a volunteer driver driving your personal vehicle, your insurance is primary. Thank you for helping us with our transportation needs. Certification I certify that the information given on this form is true and correct to the best of my knowledge. I understand driving for Church ministry is a profound responsibility and I will exercise extreme care and due diligence while driving. I understand that as a volunteer driver, I must be 21 years of age or older, possess a valid driver’s license, have the proper and current license and vehicle registration, and have the required insurance coverage in effect on any vehicle. I agree that I will refrain from using a cell phone or any other electronic device while operating my vehicle. _________________________________________ Volunteer Driver Signature

Appendix B (page 2 of 2)

__________________ Date

VOLUNTEER DRIVER FORM

Policy number: ... involving drug or alcohol (such as driving under the influence or driving while intoxicated) in the last seven years. ______ ______. 3. I have had no more than three moving violations or accidents in the last three years. ______ ______. Please be aware that as a volunteer driver driving your personal ...

66KB Sizes 1 Downloads 355 Views

Recommend Documents

VOLUNTEER DRIVER FORM
provided for each vehicle. 3. Insurance – please provide the following if driving your personal vehicle on behalf of the Diocese. Insurance Company's Name: ...

volunteer driver application.pdf
Page 1 of 1. Page 1 of 1. volunteer driver application.pdf. volunteer driver application.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying volunteer ...

volunteer registration form -
Date. Time Slot. Available (Y / N). A. Saturday June 23rd. 8:00A to 12 N. B. Saturday June 23rd. 12 N to 4 PM. C. Saturday June 23rd. 4 PM to 8 PM. D. Saturday ...

Volunteer Information Form
Special Interest, Skills, Talents, Business Contacts: Availability (Days, Hours): ... Artistic Projects (bulletin boards, posters, murals and classroom support).

Volunteer Form-Spanish.pdf
Page 2 of 15. ESCUELAS PÚBLICAS DE BATTLE GROUND. Pedido de Información de la Historia Criminal. Información de Abuso de Niños/Adultos. Por Medio ...

Volunteer Application for Commissions Form 2015 interactive.pdf ...
Phone: 215 249-3310 Fax: 215 249-9875. DUBLINBOROUGH.ORG. Please mail to the above address or drop off at the Borough Hall. APPLICANT INFORMATION. Name: Home Address: Home Telephone Number: Cell Phone Number: Number of years residing in Dublin Boroug

Volunteer Form update 182014.pdf
Date Printed: initial. Destroyed Date: initial. Retain in your files. Page 2 of 2. Volunteer Form update 182014.pdf. Volunteer Form update 182014.pdf. Open.

Volunteer Form 2015.pdf
Loading… Whoops! There was a problem loading more pages. Whoops! There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Volunteer Form 2015.pdf. Volunteer Form 2

staff / volunteer driver qualifications and vehicles authorized for ...
Apr 12, 2016 - Procedures Specific to Category of Driver and Type of Vehicle Driven. 2.1. Individuals with .... Apply for annual “Operating Authority Certificate”.

How to complete the 'Volunteer (V) blue card application form'
Commission for a blue card on the volunteer's behalf. ... provided on the blue card application form. ... usual residence is more than 50kms from the business .... Current Credit Card or account card from a bank/building society/credit union (with ..

Field Day Volunteer Shirt Form .pdf
the form below and return it along with payment to the office by FRIDAY, APRIL 24th. Sorry, but we will not be able to accept late orders. The cost is $6 per shirt ...

Updated Volunteer Form 7-2017.pdf
Empl._____ Vol/Contractor_____ _____Initial. Date Printed:______ _____Initial. Destroyed Date:______ _____Initial. Retain in your files. Whoops! There was a problem loading this page. Retrying... Whoops! There was a problem loading this page. Retryin

Field Trip Driver Form 2016_17.pdf
Page 1 of 2. ST. ANSELM SCHOOL. EDUCATIONAL FIELD TRIP DRIVER FORM. ONE FORM PER VEHICLE. PLEASE READ AND SIGN THE BACK OF THIS ...

Application-Form-RTU-Kota-Clerk-Lab-Attendant-Driver-Technician ...
RAJASTHAN TECHNICAL UNIVERSITY, KOTA .... University/Board. Div./ .... Application-Form-RTU-Kota-Clerk-Lab-Attendant-Driver-Technician-Posts.pdf.

Grab-Medical-Form-Driver-Registration-PDF.pdf
Grab-Medical-Form-Driver-Registration-PDF.pdf. Grab-Medical-Form-Driver-Registration-PDF.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying ...

driver ed registration form January 2014.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. driver ed ...

Volunteer Form.pdf
not include championships). My cash or check for $100 per child is attached. Page 1 of 1. Volunteer Form.pdf. Volunteer Form.pdf. Open. Extract. Open with.

Volunteer Opportunities.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Main menu.

Volunteer Affirmation.pdf
... another state, the District of Columbia, the Commonwealth of Puerto Rico or a ... the Pennsylvania State Police, and the Federal Bureau of Investigation,.

Volunteer Description.pdf
Individuals may volunteer to participate in a street team, at a Come. and Be Counted site, or at the deployment ... Inc, and other local youth service providers works to promote the Youth Count in the community. and facilitate the quarterly event. Pa

VOLUNTEER FORM.pdf
Riverside Academy (Area Learning Center) in Cambridge CMS (Cambridge Middle School). CPS (Cambridge Primary School) CIHS (Cambridge-Isanti High ...

Shanti Uganda Volunteer Internships
development, mother-centered care and the yogic principles of self-less service ... Income Generating Group (WIGG), the Garden Program and relevant activities ... o Provide training and workshops on entrepreneurship, business management ...

Volunteer-Policy.pdf
Page 1 of 1. RALPH C. MAHAR REGIONAL SCHOOL DISTRICT. ORANGE, MA. VOLUNTEERS POLICY. Persons who volunteer to work in the school must: 1.