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Hope College
Driver Information Form

The College’s Comprehensive Liability Carrier requires the following information from all employees/spouses and students who drive College-owned vehicles:

Please check one:

New Authorization Card    Renewal Card
 

Last Name:
First Name:
 
Middle Initial:
Student ID#:
E-mail Address:
Cell Phone:
Date of Birth:

Gender:  Male     Female
Driver’s License No: State
Department Driving For/Purpose:
 
List all traffic violations and/or accidents within the last 5 years:
(see MVR rating sheet)
Date
Type of Ticket
1.    
2.
3.
List any physical limitations (such as eyes, ears, limbs, etc):
 
List any restrictions on your driver's license:
 
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes No
Have you ever had a license, permit or privilege to operate a motor vehicle suspended or revoked?
Yes No
If yes, please explain:

Are you interested in being hired to drive for other departments?
Yes No

I have read and agree with the Hope College Vehicle Usage Policy.  I hereby acknowledge that all the above stated information is true to the best of my ability.  Driving a Hope College vehicle is a privilege that I will take seriously by obeying all college policies and state rules regarding the operation of motor vehicles while driving for and representing Hope College. I authorize Hope College to review my motor vehicle record (MVR) prior to approving me to drive a College vehicle.  As an approved College driver, I authorize Hope College to review my motor vehicle record at their discretion.
Date:

Please click the appropriate button:
Faculty/Staff            Student          *Non-employee

*Non-employees – Please indicate reason for driving college vehicle:



 

© 2013 Hope College | Transportation Department | 178 E 11th Street | Holland, MI 49423
phone: 616-395-7799 | fax: 616-395-7768