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Gateway USD |  E  3541.1  Business and Noninstructional Operations

Transportation For School-Related Trips   

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Gateway Unified School District

4411 Mountain Lakes Blvd.

Redding, CA 96003

530-245-7900

PRIVATE DRIVER APPLICATION - Page 1 of 3

Volunteers Driving Private Vehicle

Driver Requirements

Gateway Unified School District acknowledges the need for responsible volunteer drivers to provide transportation services for school activities and related business.

To ensure that private transportation services will be provided in a safe, efficient and cost effective manner, the following requirements will be met:

1. The driver must be at least age 21 to drive for business purposes and age 25 if transporting students, possessing a valid California driver's license, and have been continuously licensed for a minimum of 3 years.

2. Driver must be free of any medical condition that may affect his/her ability to operate a vehicle.

3. No alcohol or drugs will be consumed prior to, or while operating the vehicle.

4. The vehicle will be in excellent condition and repair.

5. The number of passengers shall not exceed the capacity for which the vehicle was designed.

6. No one may transport more than nine passengers plus the driver in any vehicle.

7. All occupants must wear seat belts whenever the vehicle is in motion.

8. All students who are less than 6 years of age or weigh less than 60 pounds must be properly secured in a rear seat, in a child passenger restraint system, meeting applicable federal motor vehicle safety standards. Child passenger restraint system not provided by district.

9. The use of cell phones, walkmans, pagers or other electronic devices while driving is prohibited.

10. Smoking a pipe, cigar or cigarette in the vehicle is prohibited.

11. The driver accepts the added responsibility that comes from carrying extra individuals and, therefore, will be conscientious in obeying all driving rules and regulations set forth by the State of California. The California Supreme Court has eliminated the protection of the former California Guest Law; therefore, a guest passenger may sue his/her host owner/driver.

12. All drivers must have an acceptable driving record as determined by the district policy (BP3540).

13. The driver must have an automobile liability insurance policy and assume all responsibility for all physical damage to his/her vehicle. The district's liability insurance does not extend protection to the private driver unless the driver has been deemed a volunteer/employee by the district. If deemed such, the district's liability insurance serves only as excess insurance over the driver's primary insurance.

14. Use of district vehicles is restricted to eligible district employees.

Minimum limits of insurance required of the driver are:

Bodily Injury $100,000 each person

$300,000 each occurrence

Property Damage $ 50,000 each occurrence

OR

Combined Single Limit $300,000 each occurrence

15. If the above conditions change and/or cannot be met, I will no longer participate as a driver until the requirements can be met.

I CERTIFY THAT I HAVE READ THE ABOVE DRIVER REQUIREMENTS AND THAT I AM IN COMPLIANCE WITH THEM.

Driver Name (Print):

Driver Signature:

Date:

Gateway Unified School District

4411 Mountain Lakes Blvd.

Redding, CA 96003

530-245-7900

PRIVATE DRIVER APPLICATION - Page 2 of 3

Volunteers Driving Private Vehicle

_____________________________________________________ School Year: 20__-20__

Name of School Site

DRIVER-APPLICANT INFORMATION:

Name: Date of Birth:

Address:

Driver License #: Expiration Date:

Telephone Number (Home) Cell Phone Number:

DRIVING RECORD:

1. Have you had a valid California Driver's License during the past 3 years? __Yes __ No

2. Age when first licensed? _______

3. Based on the Driving Record Table below, does your driving record meet the criteria of an "Acceptable Driver"? __ Yes __ No

4.

5.

6.

Number of Minor Violations

Within Last 3 Years

Number of At-Fault Accidents

Within Last 3 Years

0

1

2

3 or more

0

Acceptable

Acceptable

Borderline

Unacceptable

1

Acceptable

Acceptable

Borderline

Unacceptable

2

Acceptable

Borderline

Unacceptable

Unacceptable

3 or more

Unacceptable

Unacceptable

Unacceptable

Unacceptable

Minor Violations (3 Years) Any moving violation that is not a Serious Violation as shown in this Table. (Examples include, but are not limited to speeding, failure to yield, illegal passing, stop sign/light violation, improper turn, following too close, any other moving violation where DMV points are assessed).

License Suspension or Revocation for other than failure to pay fines or Driving with Suspended License

Within Last 3 Years

Unacceptable

Unacceptable

Unacceptable

Unacceptable

Any Serious Violations

Within Last 5 Years

Unacceptable

Unacceptable

Unacceptable

Unacceptable

Serious Violations (5 Years)

* Failure to stop in the event of an accident (Hit and Run)

* Driving under the influence of alcohol or drugs or with open container

* Refusing to take a substance/chemical test

* More than one dismissal of a conviction relating to controlled substances

* Reckless/Careless Driving

* Homicide or Manslaughter or using vehicle in connection with a felony

* Evading a Peace Officer or resisting arrest

* Driving the wrong way or in the incorrect lane on a divided highway

* Driving in excess of 100 mph

* Racing/Speed contests

* Passing a stopped school bus

Gateway Unified School District

4411 Mountain Lakes Blvd.

Redding, CA 96003

530-245-7900

PRIVATE DRIVER APPLICATION - Page 3 of 3

Volunteers Driving Private Vehicle

VEHICLE INFORMATION:

Name of Owner:

Address:

Telephone:

Description of Auto

Year: Make: Number of Seatbelts:

License Plate No. Registration Expiration

Number of Booster/Child Restraint Seats, if applicable

INSURANCE INFORMATION:

Auto Insurance Company: Policy No.:

Expiration Date of Policy:

Liability Limits: Bodily Injury: $________________ each person

$________________ each occurrence

Property Damage: $________________ each occurrence

~OR~

Bodily Injury and Property Damage Liability, Combined Single Limit

$________________ each occurrence

ATTACH:

* Copy of Driver's License

* Copy of Current Auto Insurance Policy

I CERTIFY THE INFORMATION PROVIDED IN THIS THREE (3) PAGE PRIVATE DRIVER APPLICATION IS TRUE AND CORRECT. I UNDERSTAND THAT, IF AN ACCIDENT OCCURS, MY INSURANCE COVERAGE SHALL BEAR PRIMARY RESPONSIBILITY FOR ANY LOSSES OR CLAIMS OF DAMAGE. TO THE BEST OF MY KNOWLEDGE, MY VEHICLE IS MECHANICALLY SOUND.

Print Driver Name:

Driver Signature: Date:

Approved Driver and Vehicle: Date:

(Designated District Official)

Exhibit GATEWAY UNIFIED SCHOOL DISTRICT

version: August 18, 2010 Redding, California

___________________________________________________________________________

E(2) 3541.1

Transportation For School-Related Trips

Gateway Unified School District

4411 Mountain Lakes Blvd.

Redding, CA 96003

530-245-7900

EMPLOYEE DRIVER APPLICATION - Page 1 of 4

Site/Department Driver Name

District Requirements

Gateway Unified School District acknowledges the need for responsible drivers to provide transportation services for school activities and related business. To ensure that transportation services will be provided in a safe, efficient and cost effective manner, all drivers must comply with the following requirements:

1. The driver must be at least age 21 to drive for business purposes and age 25 if transporting students, possessing a valid California driver's license, and have been continuously licensed for a minimum of 3 years.

2. Driver must be free of any medical condition that may affect his/her ability to operate a vehicle.

3. No alcohol or drugs will be consumed prior to, or while operating the vehicle.

4. The number of passengers shall not exceed the capacity for which the vehicle was designed.

5. No one may transport more than nine passengers plus the driver in any vehicle.

6. Transportation is limited to district business and/or transportation of students and approved chaperones for educationally based activities, sports and field trips.

7. All occupants must wear seat belts whenever the vehicle is in motion.

8. All students who are less than 6 years of age or weigh less than 60 pounds must be properly secured in a rear seat in a child passenger restraint system meeting applicable federal motor vehicle safety standards. Child passenger restraint system not provided by district.

9. The use of cell phones, walkmans, pagers or other electronic devices while driving is prohibited.

10. Smoking a pipe, cigar or cigarette in the vehicle is prohibited.

11. The driver accepts the added responsibility that comes from carrying extra individuals and, therefore, will be conscientious in obeying all driving rules and regulations set forth by the State of California. The California Supreme Court has eliminated the protection of the former California Guest Law; therefore, a guest passenger may sue his/her host owner/driver.

12. Driver must have an acceptable driving record as determined by the district policy (BP3540). The district requires a current H6 Motor Vehicle Report (10 year MVR) for driver eligibility.

13. If the above conditions change and/or cannot be met, I will no longer participate as a driver until the requirements can be met.

14. Use of district vehicles is restricted to eligible district employees.

I CERTIFY THAT I HAVE READ THE ABOVE GATEWAY UNIFIED SCHOOL DISTRICT REQUIREMENTS AND THAT I AM IN COMPLIANCE WITH THEM.

Driver Name (Print): Driver Signature:

Date:

Address:

Driver License #:

License Expiration Date:

Home Phone #: Cell Phone #:

Attach:

1. Copy of California Driver's License

2. Current H6 Motor Vehicle Report (10 year MVR)

3. Authorization for Release of Driver Record Information (DMV Form INF 1101)

4. Copy of current auto insurance policy

Approved Driver: Date:

(Designated District Official)

Gateway Unified School District

4411 Mountain Lakes Blvd.

Redding, CA 96003

530-245-7900

EMPLOYEE DRIVER APPLICATION - Page 2 of 4

Site/Department Driver Name

VEHICLE INFORMATION:

Name of Owner:

Address:

Telephone:

Description of Auto

Year: Make: Number of Seatbelts:

License Plate No. Registration Expiration

Number of Booster/Child Restraint Seats, if applicable

INSURANCE INFORMATION:

The district's liability insurance does not extend protection to the private driver/employee/volunteer unless the driver has been deemed a volunteer/employee of the district. If deemed such, the district's liability insurance serves only as excess insurance over the driver's primary insurance. The district does not provide collision or comprehensive physical damage for any private driver vehicle.

Minimum Personal Automobile Liability Limits Required:

Bodily Injury $100,000 each person

$300,000 each occurrence

OR

Combined Single Limit $300,000 each occurrence

Property Damage $50,000 each occurrence

Auto Insurance Company: Policy No.:

Expiration Date of Policy:

Liability Limits: Bodily Injury: $________________ each person

$________________ each occurrence

Property Damage: $________________ each occurrence

~OR~

Bodily Injury and Property Damage Liability, Combined Single Limit

$________________ each occurrence

I CERTIFY THE INFORMATION PROVIDED IN THIS FOUR (4) PAGE EMPLOYEE DRIVER APPLICATION IS TRUE AND CORRECT. I UNDERSTAND THAT, IF AN ACCIDENT OCCURS, MY INSURANCE COVERAGE SHALL BEAR PRIMARY RESPONSIBILITY FOR ANY LOSSES OR CLAIMS OF DAMAGE. TO THE BEST OF MY KNOWLEDGE, MY VEHICLE IS MECHANICALLY SOUND.

Sign:

(Driver Applicant)

Date:

Approved Driver and Vehicle: Date:

(Designated District Official)

Gateway Unified School District

4411 Mountain Lakes Blvd.

Redding, CA 96003

530-245-7900

EMPLOYEE DRIVER APPLICATION - Page 3 of 4

School Year: 20__-20__

Name of School Site

DRIVER-APPLICANT INFORMATION:

Name: Date of Birth:

Address:

Driver License #: Expiration Date:

Telephone Number (Home) Cell Phone Number:

DRIVING RECORD ELIGIBILITY GUIDELINES:

1. Have you had a valid California Driver's License during the past 3 years? __Yes __ No

2. Age when first licensed? _______

3. Based on the Driving Record Table below, does your driving record meet the criteria of an "Acceptable Driver"? __ Yes __ No

Number of Minor Violations

Within Last 3 Years

Number of At-Fault Accidents

Within Last 3 Years

0

1

2

3 or more

0

Acceptable

Acceptable

Borderline

Unacceptable

1

Acceptable

Acceptable

Borderline

Unacceptable

2

Acceptable

Borderline

Unacceptable

Unacceptable

3 or more

Unacceptable

Unacceptable

Unacceptable

Unacceptable

Minor Violations (3 Years) Any moving violation that is not a Serious Violation as shown in this Table. (Examples include, but are not limited to speeding, failure to yield, illegal passing, stop sign/light violation, improper turn, following too close, any other moving violation where DMV points are assessed).

License Suspension or Revocation for other than failure to pay fines or Driving with Suspended License

Within Last 3 Years

Unacceptable

Unacceptable

Unacceptable

Unacceptable

Any Serious Violations

Within Last 5 Years

Unacceptable

Unacceptable

Unacceptable

Unacceptable

Serious Violations (5 Years)

* Failure to stop in the event of an accident (Hit and Run)

* Driving under the influence of alcohol or drugs or with open container

* Refusing to take a substance/chemical test

* More than one dismissal of a conviction relating to controlled substances

* Reckless/Careless Driving

* Homicide or Manslaughter or using vehicle in connection with a felony

* Evading a Peace Officer or resisting arrest

* Driving the wrong way or in the incorrect lane on a divided highway

* Driving in excess of 100 mph

* Racing/Speed contests

* Passing a stopped school bus

EMPLOYEE DRIVER APPLICATION - Page 4 of 4

A Public Service Agency

EMPLOYEE PULL NOTICE PROGRAM

AUTHORIZATION FOR

RELEASE OF DRIVER RECORD INFORMATION

I,__________________________________, California Driver License Number ______________________, hereby authorize the California Department of Motor Vehicles (DMV) to disclose or otherwise make available, my driving record to Gateway Unified School District (GUSD).

I understand that GUSD may enroll me in the Employer Pull Notice (EPN) program to receive a driver record report at least once every twelve (12) months or when any subsequent conviction, failure to appear, accident, driver's license suspension, revocation, or any other action is taken against my driving privilege during my employment.

I am not driving in a capacity that requires mandatory enrollment in the EPN program pursuant to California Vehicle Code (CVC) Section 1808.1(k). I understand that enrollment in the EPN program is an effort to promote driver safety, and that my driver's license report will be released to GUSD to determine my eligibility as a licensed driver for my employment or transporting students.

EXECUTED AT: CITY COUNTY STATE

Redding Shasta CA

DATE

SIGNATURE OF EMPLOYEE

X

I, Mike Young, of Gateway Unified School District

AUTHORIZED REPRESENTATIVE COMPANY NAME

Do hereby certify under penalty of perjury under the laws in the State of California, that I am an authorized representative of this company, that the information entered on this document is true and correct, to the best of my knowledge and that I am requesting driver record information on the above individual to verify the information as provided by said individual. This record is to be used by GUSD in the normal course of business and as a legitimate business need to verify information relating to a driving position not mandated pursuant to CVC Section 1808.1. The information received will not be used for any unlawful purpose. I understand that if I have provided false information, I may be subject to

prosecution for perjury (Penal Code Section 118) and false representation (CVC Section 1808.45). These are punishable by a fine not exceeding five thousand dollars ($5,000) or by imprisonment in the county jail not exceeding one year, or both fine and imprisonment. I understand and acknowledge that any failure to maintain confidentiality is both civilly and criminally punishable pursuant to CVC Sections 1808.45 and 1808.46.

EXECUTED AT: CITY COUNTY STATE

Redding Shasta CA

DATE

SIGNATURE AND TITLE OF AUTHORIZED REPRESENTATIVE

X______________________________________________

Supervisor of Transportation

To obtain a driver record on a prospective employee you may submit an INF 1119 form. To add this driver to the EPN Program you must submit the applicable forms: INF 1100, INF 1102, INF 1103, INF 1103A form. You may obtain forms at our website at www.dmv.ca.gov/otherservices, or by calling 916-657-6346.

THIS FORM MUST BE COMPLETED AND RETAINED AT THE EMPLOYER'S PRINCIPLE PLACE OF BUSINESS AND MADE AVAILABLE UPON REQUEST TO DMV STAFF.

DO NOT RETURN THIS FORM TO DMV.

Exhibit GATEWAY UNIFIED SCHOOL DISTRICT

version: August 18, 2010 Redding, California

___________________________________________________________________________

E(3) 3541.1

PLEASE SEE DISTRICT MATERIAL IN DISTRICT OFFICE

FOR

EXHIBIT (3) 3541.1

ENTITLED

"DISTRICT GUIDELINES RELATING TO STUDENT TRANSPORTATION"

Exhibit GATEWAY UNIFIED SCHOOL DISTRICT

version: August 18, 2010 Redding, California