VOLUNTEER DRIVER APPLICATION FORM Date: Last Name: First

CARE Transit
Box 998 Hope, B.C. V0X 1L0
Phone: 604 869 3396 Fax: 604 869 8208
Email: [email protected]
VOLUNTEER DRIVER APPLICATION FORM
Date: __________________ Last Name: __________________ First Name ________________
Date of Birth ________________________
Gender _____________________________
Residential Address: ____________________________________________________________
Street
City
Prov
Postal Code
Buzzer Code (for those in an apartment) ___________________
Mailing Address: (if different from above)
_____________________________________________________________________________
Street
City
Prov
Postal Code
Phone: (Home) ________________ (Fax) _________________ (Cell) ____________________
Email address (if any) ___________________________________________________________
Fax
Home phone
Cell
Email
Preferred method of communication
Driving License # _____________________
Expiry Date _________________________
How long have you been driving _____________ years
Are you currently employed?
_____ Yes
_____ No
__________ months
Full Time/Part Time
(If yes please circle one)
If yes, what is your occupation? ___________________________________________________
Address of your Employment _____________________________________________________
What type of work have you done in the past? ________________________________________
______________________________________________________________________________
______________________________________________________________________________
EMERGENCY CONTACT PERSON (S)
Last Name: __________________________ First Name _______________________________
Address: ________________________ City _______________ Prov _____ Code ___________
Home Phone: ____________________ Work Phone _______________ Cell _______________
Relationship: __________________________________________________________________
Last Name: __________________________ First Name _______________________________
Address: ________________________ City _______________ Prov _____ Code ___________
Home Phone: ____________________ Work Phone _______________ Cell _______________
Relationship: __________________________________________________________________
Please answer the following questions:
What is the license plate number of the vehicle you will be using? ________________
Do you have any restrictions on your license? If so please explain. ________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Have you ever had your driver’s license suspended, revoked or refused? ___________________
If yes please explain. ____________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Have you ever done any volunteer work? If so with whom and what did you do?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
What experience personal or professional have you had with seniors, youth or children, (i.e.
caring for an elderly relative)?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
It is known that people get involved with volunteer work for four basic reasons:
Social—to be with others
Emotional—to give to others
Intellectual—to learn more
Spiritual—to enhance & share with other
What led you to consider applying to be a volunteer with this Program?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Do you feel comfortable working with and helping people of different ages, ethnic or cultural
backgrounds? Explain.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
What are your special hobbies, skills, and/or interests?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
What are your expectations of the Hope & Area Volunteer Transportation Program?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
What expectations would you have of the Hope & Area Volunteer Transportation Program
Coordinator?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
How did you hear about the Hope & Area Volunteer Transportation Program?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
What day(s), time(s) are you available for volunteer work? Please be specific with day (s) of
week and hours. For the left main box, there may be 2 different times you are available in the
day (i.e. 9 am – 1 pm and 3 pm – 6 pm on certain days. For the right main box indicate with a
check mark if you may be available outside your stated times for each day.
From
Until
From
Monday
Until
Availability outside the stated hours on the left
Tuesday
On request
On request
Emergency only
Emergency only
Not available
Not available
Wednesday
On request
Emergency only
Not available
Thursday
On request
Emergency only
Not available
Friday
On request
Emergency only
Not available
Saturday
On request
Emergency only
Not available
Sunday
On request
Emergency only
Not available
Available for last minute calls
Request Rides:
Every available day
Few days a week
Twice a month
Once a month
Once a week
REFERENCES
Name: __________________________________ Phone: _____________________________
Address: ______________________________________________________________________
Relationship: __________________________________________________________________
Name: __________________________________ Phone: _____________________________
Address: ______________________________________________________________________
Relationship: __________________________________________________________________
Name: __________________________________ Phone: _____________________________
Address: ______________________________________________________________________
Relationship: __________________________________________________________________
Confidential Information
In order to provide a safe and secure environment for children and other vulnerable people, we believe
it is necessary to include the following questions as part of our application process. The Program will
keep all information strictly confidential. (Police may access this information, under warrant, if
requested). Answering yes to any of the questions may not preclude your involvement in the program.
Thank you for your understanding.
 Are there circumstances or traits in your lifestyle or
background that would call into question your ability
to work with children, youth or other vulnerable people?
 Have you ever been arrested or convicted for the use or sale of drugs?
 Have you ever been convicted of a criminal offense?
 Do you have any pending criminal charges or convictions?
 Have you ever been accused, arrested or convicted for any
abuse-related crimes?
 Do you have any health concerns of which we should be aware?
 Have you ever been convicted of:




A felony involving a vehicle?
Reckless driving, driving while intoxicated, driving under the influence...?
Driving without insurance?
In the last 5 years, have you ever been charged with
two or more moving violations or “at fault” accidents?
Yes
No
Yes
Yes
Yes
No
No
No
Yes
Yes
No
No
Yes
Yes
Yes
No
No
No
Yes
No
If you have answered yes to any of the above questions, please explain on separate paper.
I understand that the CARE Transit will complete a minimum of 2 reference checks. I must undergo a
criminal record check and I must also supply an annual driver’s abstract, a copy of my driver’s license
and vehicle insurance at each renewal date. If the results are not satisfactory, I understand that I may be
declined a position with this program. I hereby declare that all the above statements are true and correct
to the best of my knowledge and I agree to be a volunteer for the Transportation Program.
VOLUNTEER APPLICANT ____________________________ _________________________
SIGNATURE
PRINT NAME
After an interview has been conducted you will be required to provide a driver’s abstract and a
criminal record check from the local police department. You will also be asked to sign a Position
Description and Contract that outline duties, expectations and support.
Thank you for considering CARE Transit, we appreciate your interest. Please send this
completed form via any of the methods noted on the front page to:
CARE Transit
Transportation Coordinator
Box 998, Hope, B.C. V0X 1L0
Privacy: We will never provide your personal information to any third party
without your prior written approval.