Description: Can you perform all the requirements of operating the vanpool vehicle as explained in the Volunteer Driver Selection Guidelines and have you completed the Essential Functions checklist? Yes No If no, please explain: Have you driven a van before? Yes No If yes, state for whom, when, where, how long: This application warrants a criminal history background check, and/or verification of my motor vehicle record as authorized by my signature below. My signature below authorizes the (Sponsoring Organization) to obtain, at its sole discretion, my employment For Drivers Only. and non-employment driving record, including all Department of Licensing actions that have taken place regarding the driver's license I now hold, have held, or in the future may obtain. It also authorizes the (Sponsoring Organization) to conduct a criminal history background check from the source of its choice. I further agree to any other conditions described herein. This release continues in effect as long as I continue to serve as a (Sponsoring Organization) volunteer driver. Signature: Date: Form 10 Private Vehicle Registration – Name: Address: Town: Zip: Phone: Fax: E-Mail: Vehicle(s) #1 Make: Year: Air Bag/s: Model: Color: Seating: License #: #2 Make: Year: Air Bag/s: Model: Color: Seating: License #: Insurance Company: Insurance Agent: Address: Town: Zip: Telephone: I certify that I am currently insured through the above company for automobile liability insurance in an amount in excess of or equal to the minimum required under Washington State law. (Liability: $100,000 per individual/$300,000 per occurrence/Property Damage: $50,000 per occurrence) Further, I agree to forward a photocopy of my Proof of Insurance Card at each renewal period. Further, I agree to immediately notify the (Sponsoring Organization) in the event that the above liability insurance is revoked, cancelled or altered in such a manner as to no longer meet the minimum vehicle insurance requirements for the State of Washington.
Description: Can you perform all the requirements of operating the vanpool vehicle as explained in the Volunteer Driver Selection Guidelines and have you completed the Essential Functions checklist? Yes No If no, please explain: Have you driven a van before? Yes No If yes, state for whom, when, where, how long: This application warrants a criminal history background check, and/or verification of my motor vehicle record as authorized by my signature below. For Drivers Only. My signature below authorizes the (Sponsoring Organization) to obtain, at its sole discretion, my employment and non-employment driving record, including all Department of Licensing actions that have taken place regarding the driver's license I now hold, have held, or in the future may obtain. It also authorizes the (Sponsoring Organization) to conduct a criminal history background check from the source of its choice. I further agree to any other conditions described herein. This release continues in effect as long as I continue to serve as a (Sponsoring Organization) volunteer driver. Signature: Date: Form 10 – Private Vehicle Registration Name: Address: Town: Zip: Phone: Fax: E-Mail: Vehicle(s) #1 Make: Year: Air Bag/s: Model: Color: Seating: License #: #2 Make: Year: Air Bag/s: Model: Color: Seating: License #: Insurance Company: Insurance Agent: Address: Town: Zip: Telephone: I certify that I am currently insured through the above company for automobile liability insurance in an amount in excess of or equal to the minimum required under Washington State law. (Liability: $100,000 per individual/$300,000 per occurrence/Property Damage: $50,000 per occurrence) Further, I agree to forward a photocopy of my Proof of Insurance Card at each renewal period. Further, I agree to immediately notify the (Sponsoring Organization) in the event that the above liability insurance is revoked, cancelled or altered in such a manner as to no longer meet the minimum vehicle insurance requirements for the State of Washington.
Drivers_Manual_Companion_Forms.docx