Occidental College Authorized Driver Application printable pdf download

FACULTY/STAFF, STUDENT AND VOLUNTEER DRIVER INFORMATION

RELEASE AND AGREEMENT

This form is to be completed by all faculty/staff, student and volunteer drivers using a District vehicle or

driving a personal vehicle on District business. All drivers must be age 21 or older. For volunteers and

temporary employees, having one or more points on their DMV record may disqualify them as a driver.

District vehicles MAY NOT be used for personal business at any time. Every section of this form

must be completed for approval. Please do not leave any blanks. Please print.

DRIVER INFORMATION

Location:

SCE

Status:

Hourly

Classf

F/T Faculty

Adj. Fac

Student

Volunteer

(Please check one)

Manager

(Please check one)

Driver Name:

Driver Address:

City:

State:

Zip Code:

Telephone Number:

Driver’s License Number:

Expiration Date:

Number

State

Do you maintain personal automobile liability insurance as required by California Vehicle Code:

Yes

Please attach a current copy of Driver’s License and insurance I.D. card.

I certify that the above information is true and correct. In signing this Release and Travel Waiver Agreement, I

agree to the following conditions

1. I currently hold a valid California Driver’s License for the type of vehicle being operated. My California Driver’s

License will not expire during the requested “Dates of Use”. I shall maintain a valid California Driver’s License at

all times when driving a District vehicle and/or when driving a personal vehicle on District business.

2. Should my California Driver’s License become suspended, cancelled, or revoked, I shall immediately inform the

District Risk Manager and cease driving a District owned vehicle and/or a private/rented vehicle on District

business.

3. I will maintain a personal automobile liability insurance policy as required by the California Motor Vehicle Code,

when I drive a personal automobile on District business.

4. I shall immediately inform the District Risk Manager should my personal automobile liability insurance policy

change, or become cancelled. I shall immediately cease driving a personal vehicle on District business.

5. I shall immediately cease driving a District vehicle and/or a private/rented vehicle on District business, as soon as

I receive notification by the District that I do not qualify as a volunteer driver.

6. I agree to drive in a reasonable and prudent manner and abide by all applicable State and local laws, ordinances,

and regulations.

7. My passengers and I will utilize any and all safety measures such as seat belts that the vehicle may be equipped

with, and I will refrain from any distracting activities including but not limited to the use of cellular phone while the

vehicle is in motion.

8. If I should become involved in an automobile accident while driving a District vehicle or while driving on District

business in a private automobile, I shall immediately report any and all automobile accidents that may have

caused property damage and/or bodily injury to the District Risk Manager at (714) 808-4779 and follow up with

completed “Auto Accident Report Kit” found in the glove box of District vehicles and/or provided by the facilities

office.

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Occidental College Authorized Driver Application

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