Volunteer Driver Application

Volunteer Driver Application

Please submit any copies or supplemental information to havens@snapwa.org

Please indicate what days of the week you will be available to volunteer and write down the times during those days that you will be willing to volunteer. If there are specific regular dates of the month you are not available then note them in the Comments section below.

What times are you available on Mondays?

What times are you available on Tuesdays?

What times are you available on Wednesdays?

What times are you available on Thursdays?

What times are you available on Fridays?

Comments

Have you been convicted during the last 10 years of driving while intoxicated or under the influence of drugs?

Yes

Please Explain

Indicate all moving violations or citations (other than parking) that you have been convicted of, forfeited bail, or paid any fines for during the past 3 years. Please give full details, including dates, below

Date

Time

Location (City and State)

Conviction

If speeding, legal limit

Your speed

Amount of fine in dollars

Remarks

Use this space to indicate additional moving violations or citations (other than parking) that you have been convicted of, forfeited bail, or paid any fines for during the past 3 years.

Date

Time

Location (City and State)

Conviction

If speeding, legal limit

Your speed

Amount of fine in dollars

Remarks

List all motor vehicle accidents of any type or cause that you, either as owner or operator, have been involved in during the last 5 years.

Date

Time

Driver

Violation

Who was at fault?

Damage to your vehicle?

Amount in dollars?

Bodily Injury?

Damage to other property?

Amount in dollars?

Description

List additional motor vehicle accidents of any type or cause that you, either as owner or operator, have been involved in during the last 5 years.

Date

Time

Violation

Driver

Who was at fault?

Damage to your vehicle?

Amount in dollars?

Bodily Injury?

Damage to other property?

Amount in dollars?

Description

This application warrants a criminal history background check, and/or verification of my motor vehicle record as authorized by my signature below. My signature below authorizes SNAP to obtain, at its sole discretion, my employment and non-employment driving record, including all Department of Licensing actions that have taken place regarding the driver's license I now hold, have held, or in the future may obtain. It also authorizes SNAP to conduct a criminal history background check from the source of its choice. I further agree to any other conditions described herein. This release continues in effect as long as I continue to serve as a SNAP volunteer driver. Refer to the DSHS Secretary’s Crimes List for disqualifying crimes and actions.*

Electronic Signature

Date

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