CPO Approved Driver Request Form

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1 CPO Approved Driver Request Form This form is used to: request approval to drive volunteers and service recipients in CPO vehicles submit updated driver's license This form must be submitted by the applicant - it cannot be submitted on behalf of someone else! Approval is required to drive CPO vehicles. For new drivers, submission of this form will require you to: agree to a variety of terms and conditions upload a legible photo or scan of the front side of your valid driver's license upload a completed scan of the required DMV form (link provided in this application) upload signed CPO Liability Form #1 and #2 (link provided in this application) Upon review of your submission, we will submit your information to UCLA Fleet Services and the California DMV to request a report of your driving record (this applies to all applicants regardless of the state that issued their drivers license). Additionally, we will enter you into a "pull notification system", which will alert us of any future activity on your driving record. You will remain in the pull notification system until the end of the current academic year, at which time you will be removed from the system and no longer eligible to drive (returning drivers may reapply the following academic year.) For applicants who possess a California driver's license, we typically receive your driving record within three business days. For applicants who possess a license issued by another state, we typically receive your driving record within three weeks. If you would like to drive sooner, you should complete this process and obtain a current driver record from the state that issued your license. Most states allow you to obtain this information on their website for a nominal fee. Driver records should be submitted to Ruth Tesfai by at rtesfai@cpo.ucla.edu. In addition to submission into this DMV pull notification system, all drivers must also complete the driver s safety training course. Classes are posted on the SREC page on Orgsync. Once your application is approved, you are considered an approved driver and are eligible to begin driving CPO vehicles. You will receive an OrgSync notification indicating your submission has been approved and you will be added to the approved driver list, which can be found under the people tab on the left side navigation. If your application is denied, you will receive an indicating the reason for your denial. After submitting this application, please apply for your CPO ID which is required for vehicle checkout. The link for the application is If you have any questions regarding the process, feel free to contact Ruth Tesfai, the CPO Transportation Services Manager, at Type of Request Why are you submitting this form? [Required] [ ] To request to become a new driver [ ] To renew my status (for those previously approved) - NO updated information [ ] To renew my status (for those previously approved) - updated information Minimum Requirements The following are minimum requirements that must be met to become and to remain an approved driver: May not have a DUI, reckless driving, or other convictions that have led to a license suspension or revocation. May not have any physical impairment that impacts your ability to drive. Must be at least 18 years of age. Must have a valid driver's license from one of the 50 states. Terms and Conditions Checkbox [Required] I certify that I meet all of the minimum requirements listed above and understand that if for any reason I no longer meet one or more of the minimum requirements listed above, it is my responsibility to notify the CPO Transportation Services Manager. [ ] I Certify Please enter your University ID number. [Required] - can not contain any spaces. Provide when you completed Driver's Safety Training (MM/DD/YYYY). [Required] If you are driving for a project under CPO and took the course 2 years ago, your certification is no longer valid. For example, if you took the course Fall 2014, you must retake it Fall Page 1 of 7 CPO Approved Driver Request Form

2 General Travel Policies General Travel Policies [Required] I understand that any approved driver who violates one or more of the general travel policies listed above may be subject to disciplinary action that may include loss of approved driver status. and Agree to Abide by All Policies Specific Driver Policies The following Driver Policies apply to all approved drivers while traveling. Must have your valid driver's license in your possession while driving. Must drive safely and obey all state and local laws/ordinances. Must wear a seat belt at all times; must ensure passengers are wearing seat belts at all times. Must follow rules for vehicle use. Must refrain from consuming alcohol and/or illegal substances; refrain from prescriptions or over-the-counter drugs which may cause drowsiness (check the label or ask pharmacist). Must refrain from distracting behaviors while driving (e.g. eating, smoking, adjusting radio controls, etc.) Cell phones must not be used while driving even if used with a hands-free device, unless it is an emergency situation. Must only transport individuals who are on University business (no family members, hitchhikers or friends). Must check the vehicle prior to driving to ensure it is fully operational and safe to drive. Must not operate vehicle if any of the following are not operating properly: engine, transmission, brakes, tires, lights, steering. Must not operate in extreme weather including: rain, snow, ice or fog. Agreement Terms [Required] I understand that any approved driver who violates one or more of the driver policies listed above (while traveling on CPO business) may be subject to disciplinary action that may include loss of approved driver status. Driver Agreement Understanding Please read through each of the terms listed below. If you understand a term, please click "I Understand". If you do not understand a term, please contact the CPO Transportation Services Manager, Ruth Tesfai, at (310) Personal Responsibility [Required] I understand that I am personally responsible for any traffic citations that I may receive and that the Community Programs Office will not pay for or reimburse for such costs. Payment must be made before or by due date to ensure CPO vehicles are not affected. Accident Reporting [Required] I understand that I must report any accident that I am involved in within 48 hours (complete a vehicle accident report.) Driver's License [Required] I understand that if my driver's license is suspended, is no longer valid, or if I am cited for DUI, I agree to notify the Transportation Services Manager immediately and indicate that I am no longer eligible to drive. I understand that if I fail to notify the Transportation Services Manager of a suspended license or DUI citation, and I drive a University vehicle), on behalf of myself, my heirs, executors,administrators, insurers, and assigns, I agree to defend, idemnify, and hold the Regents of the University of California harmless from any and all injuries to me, including death, that occur while I am driving. Failure to notify the Transportation Services Manager of a suspended driver's license or DUI citation may also lead to suspension of driving privileges. Moving Citations and Supplemental Discipline [Required] I understand that any violation of policy or law that may occur while traveling may be subject to review by Transportation Services Manager. Page 2 of 7 CPO Approved Driver Request Form

3 Driver Authority The driver is responsible for the safe operation of a vehicle and therefore has the authority to enforce all policies and to ask for compliance from all passengers. Driver is empowered to discontinue trip until all problems are resolved. Terms and Conditions Checkbox [Required] I understand the responsibility and the authority that I have as an approved driver. Approved Driver Status I understand that I may not drive on official University business until my form/application has been approved. I will know this form/application has been approved when I receive an Orgsync message indicating my form/application has been approved (you can also check the status under My Submissions.) I understand that if I drive prior to receiving approval, I am violating CPO policy, as well as the UCLA Student Code of Conduct, and violation will result in appropriate disciplinary actions. Terms and Conditions Checkbox [Required] I understand that I may not drive on official University business until this form has been approved. General Information What State's drivers license do you hold? [Required] [ ] California [ ] Other US State What date does your driver's license expire? (submit copy of license below) [Required] What project are you requesting to drive for? [Required] [ ] AB540 [ ] Adelante [ ] AEP [ ] APHC [ ] BaYa [ ] BBE [ ] BHP [ ] BLAIDS [ ] Bruins in Focus [ ] Bruins Movin' [ ] DoTOrg [ ] Flying Samaritans [ ] IMHOME [ ] LGL [ ] LSHP [ ] LEAP [ ] MESH [ ] MHI [ ] MENTE [ ] ProMinds [ ] Proyecto de Jornaleros [ ] RYEP [ ] SANAA [ ] UMMA [ ] Saving Hearts Foundation [ ] Other If you selected Other, please enter the name of the project you are requesting to drive for. Page 3 of 7 CPO Approved Driver Request Form

4 Status [Required] [ ] CPOSA Volunteer [ ] *Other (describe below) Status - Other If you selected Other as your status, what is your status? [Required] Applicant Information - Other State Although we have the ability to check driver's records from all 50 states, the time that it takes to check the record of a driver from a state other than California is significantly longer because we must submit paperwork directly to the California DMV and wait for them to request the driver's record from the driver's home state - the process typically takes 3 weeks. Since a driver can't be approved to drive until we have reviewed his or her driver's record, a driver can either wait the estimated 3 weeks, or request a copy of his or her driver's record directly from their home state. Please note, this application must still be submitted even if providing a copy of your driver record! To assist out of state drivers, we have provided select state's links to information regarding obtaining a driver record or abstract. Arizona Nevada Illinois Contact Information [Required] - must be digits long and may include only numbers, hyphens, and spaces. - name@myschool.edu First name: Middle initial: Last name: address: Phone number: Address: City: State: ZIP: Driver's License [Required] Upload a clear picture or scan of your driver's license. What is your middle name? [Required] What State's drivers license do you hold? [Required] Driver Record or Abstract If you obtained your driver's record or abstract, you can upload it here. If you prefer, you can it to transportation@cpo.ucla.edu. If you do not provide an abstract, remember, you will need to wait an estimated 3 weeks before you are approved to drive. Applicant Information - California Contact Information [Required] - must be digits long and may include only numbers, hyphens, and spaces. - name@myschool.edu Page 4 of 7 CPO Approved Driver Request Form

5 First name: Middle initial: Last name: address: Phone number: Address: City: State: ZIP: Driver's License [Required] Upload a clear picture or scan of your driver's license. Driver's License Number [Required] Enter your driver's license number. If you enter the number incorrectly this will delay your application! DMV Form All applicants regardless of state must click this link to access a DMV Authorization for Release of Driver Record Information. To access the form, copy and paste this URL into a new window: Since the form requires your signature, you will need to print the form, complete and sign the form, and return the form to us. To expedite the review of your application, we ask that you scan the form and attach it below. You may also return the form to us: Via to transportation@cpo.ucla.edu. Via fax - to (310) In-person to the Transportation Services Manager located in the Community Programs Offices, SAC B02A, Monday-Friday between 10 am - 5 pm. DMV Form [Required] It is preferred that you print the form, complete and sign the form, then scan and upload the form here. If not, you may submit the form via one of the other options listed above. CPO Liability Forms All applicants are required to sign and submit CPO's Liability Forms. To access the forms, copy and paste this URL into a new window: Since the form requires your signature, you will need to print the form, complete and sign the form, and return the form to us. To expedite the review of your application, we ask that you scan the form and attach it below. You may also return the form to us in the following ways: Via to transportation@cpo.ucla.edu. Via fax - to (310) In-person to the Transportation Services Manager located in the Community Programs Offices, SAC B02A, Monday-Friday between 10 am - 5 pm. CPO Liability Form #1 [Required] It is preferred that you print the form, complete and sign the form, then scan and upload the form here. If not, you may submit the form via one of the other options listed above. CPO Liability Form #2 [Required] It is preferred that you print the form, complete and sign the form, then scan and upload the form here. If not, you may submit the form via one of the other options listed above. Applicant Quiz - Question 1 After I submit my application, I am approved and able to begin driving. [Required] [ ] True [ ] False Applicant Quiz - Question 1 Page 5 of 7 CPO Approved Driver Request Form

6 Incorrect - You will not be approved to drive until your application has been reviewed. Once approved, you will receive an Orgsync notification indicating your application has been approved and you will be added to the list of approved drivers (which is found under the people tab on the left side navigation bar). If you drive before you are approved, you are jeopardizing your status within the project, the project's transportation privileges, and may be subject to disciplinary action. Applicant Quiz - Question 1 Correct - You will not be approved to drive until your application has been reviewed. Once approved, you will receive an Orgsync notification indicating your application has been approved and you will be added to the list of approved drivers (which is found under the people tab on the left side navigation bar). If you drive before you are approved, you are jeopardizing your status within the project, the project's transportation privileges, and may be subject to disciplinary action. Applicant Quiz - Question 2 While driving on official University business, I am responsible for the vehicle that I am driving, as well as the passengers in the vehicle. [Required] [ ] True [ ] False Applicant Quiz - Question 2 Correct - You are personally responsible for the vehicle you are driving and for the passengers. You have the authority to act accordingly based on weather conditions, passenger conduct, and vehicle capabilities. If at any time during travel you think you need to stop - stop until you believe it is safe to resume travel! Applicant Quiz - Question 2 Incorrect - You are personally responsible for the vehicle you are driving and for the passengers. You have the authority to act accordingly based on weather conditions, passenger conduct, and vehicle capabilities. If at any time during travel you think you need to stop - stop until you believe it is safe to resume travel! Applicant Quiz - Question 3 If I am involved in a traffic accident or I receive a citation, I must notify the Transportation Services Manager within 48 hours. [Required] [ ] True [ ] False Applicant Quiz - Question 3 Correct - If you are involved in an accident you must complete a University vehicle accident report within 48 hours. If you receive a citation, you must notify the Transportation Services Manager. Applicant Quiz - Question 3 Incorrect - If you are involved in an accident you must complete a University vehicle accident report within 48 hours. If you receive a citation, you must notify the Transportation Services Manager. Updated Information Great, you have updated information for us! This option can only be selected if you are an approved driver, or a previously approved driver. Contact Information [Required] - must be digits long and may include only numbers, hyphens, and spaces. - name@myschool.edu First name: Middle initial: Last name: address: Phone number: Address: City: State: ZIP: Page 6 of 7 CPO Approved Driver Request Form

7 Provide your updated driver's license here. [Required] If you are providing an updated driver's license, please upload here. Provide when you completed Driver's Safety Training (MM/DD/YYYY). [Required] If you are driving for a project under CPO and took the course 2 years ago, your certification is no longer valid. For example, if you took the course Fall 2014, you must retake it Fall Page 7 of 7 CPO Approved Driver Request Form

THANK YOU. O ehalf of Philadelphia s a i als, tha k you for volunteering! ACCTPHILLY.ORG TRANSPORT DRIVER MANUAL

THANK YOU. O ehalf of Philadelphia s a i als, tha k you for volunteering! ACCTPHILLY.ORG TRANSPORT DRIVER MANUAL TRANSPORT THANK YOU O ehalf of Philadelphia s a i als, tha k you for volunteering! ACCTPHILLY.ORG 267-385-3800 DRIVER MANUAL Revised 2/2014 Disclaimer Purpose of Volunteer Policies Animal Care and Control