Fillable Driver Application ValidStateDriver'sLicenseInformation (Eastern University)

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Driver Application ValidStateDriver'sLicenseInformation (Eastern University)

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Driver Application

Name: Date:

EasternID: Email:

IfaStudent,SponsoringDepartment:

IfanEmployee,TitleandDepartment:

AreyouaFull‐Time'HiredDriver'forEastern?YesNo

ValidStateDriver'sLicenseInformation

easeattac

acopyo

yourDriver

sLicense

State: DateofBirth:

LicenseNumber: YearsDriving:

Signature

Van Driving Application

NewLicense Renewal

Alldriversoflargepassengervansmustcompleteadditionaltraining.

TheEasternUniversityVanLicenseisvalidfortwoyearsfromthedateissuedandmayberevokedforunsafedriving.

PleaseChecktheFollowing:

IhaveattachedacopyofmyStateDriver'sLicense

IhaveviewedtheEUDriverSafetyVideoandattachedthecertificateofcompletion

IhavereadEastern'sVehiclePolicy

Initial Date

ApplicantSignature Sponsor/ SupervisorName

Sponsor/SupervisorSignature

DriverApplication:May2013 Fin/Ops

DriversofUniversityvehiclesmustbetwenty(20)yearsofageorolder,andhaveastatedrivinghistorythatconformswith

requirementsoftheUniversity'sinsuranceprovider.Thoseseekingapprovaltooperatelargepassengervansmustalso



completethelowersectionofthisform.

SubmitthecompletedformtoFinanceandOperations.You'llbenotifiedwithin2‐3weeksofyourapprovalstatus.

Tobecompletedbyindividualsseekingapprovaltodrivelargepassengervans:

SubmitthecompletedformtoFinanceandOperations:

NEWDRIVERSmustscheduleavandrivingtestwithSecurityaftertheirDMVReportisconfirmed.

RETURNINGDRIVERSwillreceivetheirRenewedVanLicenseviacampusmail.

Bysigningbelow,IauthorizeEasternUniversitytoobtainmyStateDriver'sHistory.Further,IauthorizetheUniversityto

verifymyDriver'sHistory

onanannualbasis.Iaffirmthatallinformationprovidedhereinistrueandcorrect.

Uponapproval,whiledrivingUniversityvehicles,Iagree:thatIwillnotusemobileorelectronicdevices;tocomplywith

alltrafficroadsigns(on‐andoff‐campus);tousesafetybeltsinaccordancewithstateandfederalregulations;andto

complywithapplicablelawsandregulations.

DriverLogged:

Iherebyaffirmthatallinformationprovidedistrueandcorrect.

OfficeUseOnly:

DrivingTest

Completed:

OfficeUseOnly:

Driverwillnotbeauthorizedif:

A.Morethan2violationslastyear

B.Morethan3violationsinlast3years

C.Majorconvictionsinlast5years

Driversmustbe20 yrsofageorolder.

DriverAuthorizationmayberevokedif:

A.EasternVehicleisdamaged

B.Violations/Finesincurred

C.FutureDMVReportsdon'tcomply

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