Wendover Community Car Driver Application Form
Dear Prospective Wendover Community Car Driver

Thank you for your interest in joining us. If you would like to know a bit more before applying please email wendovercommunitycar@gmail.com with a contact number and we will give you a call.

Press the submit button at the bottom of the form when you have finished. You should see an automatic acknowledgement if the submission was successful. You will need your licence to hand to answer one of the questions. (If you would like to print a copy of your responses please do it before submitting - you can't do it afterwards)

In 2018 new data protection regulations will apply known as GDPR. As a small not for profit charity we are except from these regulations. However the data you supply will only be used in connection with the activities of the Wendover Action Group whose sole function it to manage and operate the Wendover Community Car. Your data will be stored securely and not supplied to any other organisation unless legally required to do so.

Additional information my be required from our insurers if you have any convictions or accidents during the last 5 years

We do not accept drivers with medical conditions notifiable to the DVLA. For a list of such conditions
please see https://www.gov.uk/driving-medical-conditions

The vehicle we use has a manual gearbox and has not been adapted for a disabled driver. There is no heavy lifting involved but there will be frequent entry and exit from the car and general assistance to passengers with shopping bags and seatbelts, for instance.

We will need a photocopy of your licence, a print of the record held by the DVLA and a passport type photo for your ID badge. These can be supplied to us by email if you wish, using the address above

Follow this link to print your DVLA record https://www.viewdrivingrecord.service.gov.uk/driving-record/licence-number?

If you would rather complete your application on paper, or have any questions, let us know by email or phone 01296 317769

Jeremy Stevenson (Coordinator of Insurance for Wendover Action Group)

Thank you.

(VER2.0 (16/10/2016)

Title *
Mr, Mrs, Ms, Miss etc
Your answer
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
Post Code *
Your answer
Date of Birth *
Your answer
Current Licence Expiry Date *
ITEM 4b on licence or expiry of entitlement to category B or next higher category (ITEM 14 on reverse of licence) , whichever is earlier DD/MM/YY
Your answer
Your usual daytime contact phone number *
Your answer
Alternate contact phone number
e.g. Mobile
Your answer
Your preferred email address *
Your answer
Occupation *
Your job, profession, retired or unemployed
Your answer
Motoring Offences pending or less than 5 years old *
Convictions or Prosecutions (incuding pending prosecutions) Please include date, fine or penalty and offence code if known. Input 'None' if that applies.
Your answer
Claims or Losses less than 5 years old *
Details of any motor insurance related accidents or losses (whether or not you made a claim or it was settled by a 3rd party) which involved your vehicle or which occourred whilst you were driving anybody else's vehicle. Input 'None' if that applies.
Your answer
Please provide the name and address of two people whom we may contact for a reference. They should be over 18, not a family member and have known you for at least two years *
Your answer
Declaration *
1. I am able to read a standard seven character vehicle number plate (with glasses or contact lenses if necessary) from 20 metres 2. I agree that the above information may be kept on file for so long as I am a volunteer driver for Wendover Action Group or have been authorised by Wendover Action Group to drive the vehicle or as required by our insurers. 3. I agree to provide details regarding claims or potential claims to Wendover Action Group, its brokers or insurers, in respect of any incidents arising whilst I am in charge of the Wendover Action Group's vehicle. 4. I agree to notify immediately the Wendover Action Group's Coordinator of Insurance of changes to my occupation or employment status, (including any part-time work.) or of any medical condition which may affect my ability to drive. 5. I agree not to transport any passengers who are not wearing a seat belt or appropriate restraint system in the case of infants, children or wheelchair users. 6. I do not suffer from any medical conditions notifiable to the DVLA
Date *
Date you sent this form DD/MM/YY
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service