Driver Application Form

All information contained in this document will be kept confidential. All drivers will be required to re-submit this form annually. The personnel chairman will determine driver qualification and maintain a permanent record of qualified drivers.

Driver's License Information

*

Year of application

*

Driver's Last Name:

*

Driver's First Name:

*

Driver's License Number:

*

State of Issue

*

Expiration Date: (mm/dd/yyyy)


Contact Information

*

Current Street Address:

*

City:

*

State:

*

Zip:

*

Home Phone:

Cell Phone:


Insurance Information

*

Insurance Company:

*

Insurance Policy Number:

*

Have you been convicted of any moving violations in the last five years?

Yes   No
*

Describe any medical conditions that could affect your ability to safely transport students and adults.

If you have no such conditions, type the word "None".

* Email Address: