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Volunteer Driver Application Form

This form must be attached to a completed "Volunteer Worker's Application & Registration Form".

Driver Information

Driver Name:

Date of Birth:

Position:

□ Staff   □ Volunteer   □ Intern   □ VIP   □ Other: __________________

Driver's Licence Number:

State:

Is your private vehicle being used?

□ Yes (complete the rest of this section)
□ No (skip to next section)

Vehicle Insurance Held With:

Level of Vehicle Insurance:

□ Comprehensive
□ Third Party Fire & Theft/Third Party Only
□ None

Have you ever had Vehicle Insurance cancelled or denied?

□ No
□ Yes, Reason: ________________________________________________________
________________________________________________________________________
________________________________________________________________________

Motor Vehicle Accident History (Last 5 Years)

Year of Accident

Details of the Incident (Only note AT FAULT accidents):






Traffic Infringements, Convictions, or Prosecutions (Last 5 Years)

Date Incurred

Nature of Infringement, Conviction, or Prosecution




Licence Cancellation or Suspension

Date Incurred

Reason for Cancellation or Suspension

Period of Time Enforced






I confirm that the information I have supplied on this form is true and correct to the best of my knowledge. Should it be found the answers are untrue, I understand that may be grounds for dismissal from the position held.

Signed: ________________________________________________  Date: ______________

 

 

For Office Use Only:


Date Received:

Processed by:

Outcome:

□ Approved
□ Not Approved

Comments:

 

 

This form should be kept on file along with a copy of the driver's current driver's licence.

 

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