Application of Van/Bus Driver

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Stephen Ministry

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Stephen Ministry

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APPLICATION FOR QUALIFIED DRIVER STATUS

CHURCH

POLICY #

CHURCH ADDRESS

ARE YOU AN EMPLOYEE?

YES

ARE YOU A VOLUNTEER?

YES

NAME OF DRIVER APPLICANT

DATE OF BIRTH

SOCIAL SECURITY NUMBER

DRIVER'S LICENSE NUMBER

STATE

CDL?

YES

WILL YOU BE DRIVING A 15 PASSENGER VAN?

YES

HAVE YOU COMPLETED THE DDC (DEFENSIVE DRIVING COURSE)?

YES

ADDRESS(ES) FOR PAST THREE YEARS

DRIVING RECORD: LIST ALL ACCIDENTS AND TRAFFIC CONVICTIONS OF PAST THREE YEARS, INCLUDING OCCURRENCE DATE

PLEASE INITIAL CONFIRMING YOU HAVE READ THE FOLLOWING STATEMENT: EMPLOYEES AND VOLUNTEERS DRIVING THEIR OWN PERSONAL VEHICLE ON CHURCH BUSINESS ARE STRONGLY RECOMMENDED TO CARRY MINIMUM PERSONAL AUTO LIABILITY LIMITS OF $100,000 / $300,000 / $100,000.

PLEASE INITIAL CONFIRMING YOU HAVE READ THE FOLLOWING STATEMENT: NO DDC OR CDL IS REQUIRED IF DRIVING A 15 PASSENGER VAN AT THIS TIME BUT MUST MEET ALL GUIIDEONE REQUIREMENTS. (The church has a copy of these guidelines.)

SIGNATURE: (By typing your name below, you agree that this is legal and valid as a wet signature.)

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Oakland Avenue Presbyterian Church

421 Oakland Avenue, Rock Hill, SC 29730

Phone : 803.327.2006 Email : oapc@oapc.net

Office Hours : Monday - Friday, 8:00 a.m - 4:00 p.m.

For after hours emergency contact, please call 803.329.6276

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