Alive Ministries Approved Volunteer Driver Request Form
Drivers must be 25 years or older, have passed a background check through Alive Ministries, have a valid driver’s license, and proper insurance on the vehicle used to transport participants Alive Ministries’ activities.
GENERAL INFORMATION
Last Name *
Your answer
First Name *
Your answer
Phone # 1: (XXX-XXX-XXXX- Mobile or Home) *
Your answer
Phone # 2: (XXX-XXX-XXXX- Mobile or Home)
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email: *
Your answer
Date of Birth *
MM
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DD
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YYYY
Social Security Number (XXX-XX-XXXX) *
Your answer
Driver's License Number *
Your answer
Driver's License State *
Your answer
Auto Insurance Carrier *
Your answer
Auto Insurance Phone # *
Your answer
Policy # *
Your answer
Please check all that relates. Copies may be sent via email to khristy@aliveinjenison.org. If you need help, contact the office (ex: for Volunteer Background Check Form or for recent background check date). *
Required
Date of Background Check. (Contact the office for Volunteer Background Check Form or for recent background check date.) *
Required
Is there is any reason why you should not be driving a van or car with passengers? *
Yes- explanation.
Your answer
Addresses in last 7 years, From- To *
Your answer
Confirmation
The information contained in this application is correct to the best of my knowledge. I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Alive Ministries or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. I understand that Alive Ministries and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicant’s personal information, including, but not limited to, addresses, social security numbers, and dates of birth.
I agree *
Signature (Full Name, Last 4 digits of SS#.) *
Your answer
Date *
MM
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DD
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Submit
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