Willow Glen Bible Church

Volunteer Driver APplication Form

I AM APPLYING TO BE A VOLUNTEER DRIVER (DRIVE MINORS IN MY PERSONAL OR BORROWED VEHICLE).

THE PURPOSE OF THIS FORM IS TO PROTECT THOSE PARTICIPATING IN CHURCH ACTIVITIES BY BEING SELECTIVE IN THE DESIGNATION OF PERSONS AUTHORIZED TO DRIVE PERSONAL AND/OR BORROWED VEHICLES FOR CHURCH SPONSORED TRIPS. PLEASE FILL OUT THIS FORM AND RETURN IT, ALONG WITH COPIES OF YOUR DRIVER'S LICENSE AND YOUR CURRENT VEHICLE INSURANCE DECLARATION PAGE TO THE CHURCH ADMINISTRATOR. A NEW VOLUNTEER DRIVER APPLICATION FORM MUST BE FILLED OUT EACH CALENDAR YEAR. ALL REFERENCES TO CHURCH OR WGBC IN THIS APPLICATION MEAN WILLOW GLEN BIBLE CHURCH IN SAN JOSE, CALIFORNIA.

If you would prefer to fill out a paper form and hand it in to the WGBC office staff, use the button below.

WGBC Volunteer Driver Application Form PDF

SECTION 1--PERSONAL INFORMATION

SECTION 1--PERSONAL INFORMATION: Enter your LAST NAME, FIRST NAME, & MIDDLE INITIAL

Cell Phone Number & Home Phone Number (if applicable)

Address 1

Address 2

City

State

Zip

Date of birth

Driver's License Number

Driver's License Expiration Date

Number of Years Driving Experience

SECTION 2--VEHICLE INFORMATION: List any owned vehicles that the church may use for transportation: 1) Make/model

2) License Plate Number

3) Number of Working Seatbelts

SECTION 3--INSURANCE INFORMATION: (For those applying to be drivers) The church prefers volunteer drivers of private vehicles to have a minimum amount of liability insurance. 1) $100,000 per person for bodily injury 2) $300,000 liability per incident for bodily injury for all vehicle occupants AND 3) $50,000-$100,000 liability for property damage. Please attach a copy of your insurance policy's declarations page. If more than one vehicle is to be used, please attach the required information for each vehicle. LIST YOUR INSURANCE COMPANY NAME:

Insurance Policy Number

Insurance Agent's Name

Insurance Agent's Phone Number

1) $ Liability/person bodily

2) $ Liability/incident

3) $ Liability property

SECTION 4--DRIVING RECORD INFORMATION: Have you been in an at-fault accident in the last three (3) years?

Have you been ticketed for moving violations within the last three (3) years?

**PLEASE NOTE** The church may not use volunteers who say yes to any of the following: Have you been convicted or has your license been revoked or suspended for a) Reckless or negligent operation of a vehicle b) Hit and run c) Permitting an unlicensed person to drive d) Driving while under license suspension or revocation e) DWI/DUI of alcohol or drugs f) Evading a peace office g) Using any motor vehicle in the commission of a felony h) Unlawfully leaving the scene of an accident i) Unlawfully transporting a controlled substance or hazardous material j) Speed over 100 MPHk) Grand theft

If you answered YES to any of the above questions, please write a description of the ticket(s), infraction(s), or accident(s), and any related attendance of traffic school. Otherwise type N/A.

SECTION 5--DRIVERS REQUIREMENTS & DECLARATIONS: List the Calendar Year you are applying to drive for:

I certify that for the calendar year listed above for which I have volunteered to be a WGBC driver that I possess a valid driver’s license from the State of California. (Please turn in a copy of your license.)

I understand that it is my responsibility to determine if my vehicle insurance has any liability policy limits or exclusions regarding transporting church groups that might affect my ability to meet the qualifications for a volunteer driver.

I will maintain the minimum insurance coverage required by the church for volunteer vehicle(s) listed in Vehicle Information and only volunteer to drive when such insurance policies and coverage listed in Insurance Information are in force.

When driving my privately owned vehicle, I understand that in case of any accident, injury, or vehicle damage, the church’s liability insurance policy does not provide primary or direct insurance on my vehicles. The church’s insurance may take effect only after my personal auto insurance limits are exhausted and does not provide any comprehensive or collision coverage on my vehicles(s). Damage to any private vehicle is the responsibility of the vehicle owner.

To my knowledge, my vehicle has a current, valid registration and operating license, is in safe operating condition (brakes, tires, etc.) and complies with all applicable California laws.

I am in good physical and mental health, it is safe for me to drive and neither my driver’s license nor my ability to operate a vehicle is limited by any medical, physical, or emotional restriction or condition.

 I understand that, if approved as a Volunteer Driver, I have a continuing obligation to advise the church of any change in information provided on this form including, but not limited to, involvement in a car accident in which I am cited, any citations for moving violations, non-renewal of license, termination of license, change of insurance company, change in amounts of insurance coverage, termination of insurance, or change in vehicle. I will promptly provide this information.

I affirm that I have read the WGBC Driver Expectations and will comply with these expectations while driving my own (or borrowed) vehicle for WGBC events.

I affirm that I will carefully transport all persons under my care, including obeying all traffic laws and the church transportation policy.

I certify that the information given by me on this form is true and correct to the best of my knowledge, and grant Willow Glen Bible Church permission to obtain a copy of my motor vehicle driving record and to conduct any driver or criminal record check deemed appropriate by the church. I release Willow Glen Bible Church and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims, or lawsuits in regard to the information obtained from any and all of the above referenced sources used.

Typing my name is my signature

Date

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WILLOW GLEN BIBLE CHURCH

Volunteer Driver APplication Form

Your application is not valid until we receive a copy of your driver's license and your insurance policy's declarations page.

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