Transportation for School-Related Trips Exhibit A

Transportation for School-Related Trips

Driver Registration Form

Important: This form must be submitted to the Transportation Department at least 30 days prior to the trip.

DRIVER INFORMATION: (check one) ? Employee ? Volunteer

Name:

Birthdate:

Address:

City:

Phone Number:

Cell Number:

Driver's License# & State:

License Expiration Date:

REQUIRED DOCUMENTS

Picture of valid drivers' license

Fingerprints- Obtain form at District Office, Teresa Davies, 760-769-4821 ext. 234

H-6 DMV printout (District will obtain)

I authorize the District to obtain my driving record.

Signed:

Date:

DRIVER STATEMENT

I certify that I am at least 21 years of age and hold a valid California Driver's License. I have not been convicted of reckless driving or driving under the influence of drugs or alcohol within the past five years and that the information given above is true and correct. I understand and agree to the District obtaining my drivers' record. I give authorization to be included in a District DMV Pull Notice Program (pull notice means district will be notified of any change in driving record.)

Signed:

Date:

FOR TRANSPORTATION USE ONLY

Picture of valid drivers' license

Fingerprints

H-6 DMV printout Director of Transportation Signature Date

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